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Credentialing Specialist
1 month ago
Under the general supervision of the Credentialing Manager, this role performs a variety of clerical and administrative functions to provide support and assistance in day-to-day activities of the Patient Financial Service Credentialing Department. The ideal candidate will have a high school level of knowledge or equivalent, with a minimum of one to two years of experience in credentialing and/or privileging within a hospital or managed care environment.
Key Responsibilities- Receives and audits incoming requests for enrollment and provider documentation.
- Answers phone calls from providers, practice managers, directors, and health plans.
- Handles and resolves provider/practice manager complaints and inquiries via email or phone.
- Processes customer and account source documents by reviewing data for deficiencies and resolving discrepancies.
- Prepares source data for database entry by compiling and sorting information, establishing entry priorities, and entering provider data in the requested format.
- Verifies entered customer and account data by reviewing, correcting, deleting, or reentering data.
- Maintains provider records in the credentialing database by entering new and updated customer and account information.
- Reports needed changes for processes and process improvement.
- Maintains customer confidence and protects operations by keeping information confidential.
- Maintains productivity measures/quality measures as defined by the Credentialing Department.
- Maintains quality assurance, safety, environmental, and infection control in accordance with established system policies, procedures, and objectives.
- Contributes to team effort by accomplishing related results as needed.
- Assists PFS Credentialing staff in their absence, responding and/or forwarding incoming requests, answering phones, taking messages, and assisting with departmental functions.
- Participates in educational programs as directed.
- High school level of knowledge or equivalent required.
- Minimum one to two years of experience in credentialing and/or privileging within a hospital or managed care environment.
- Must have at least one year of experience in a healthcare office environment.
- Proven expertise in the healthcare physician credentialing, expirables management, re-credentialing, and provider enrollment environment.
- Highly motivated and success-driven with the ability to implement and manage cross-functional projects.
- Proficient in Microsoft Office and knowledge of Intellicred credentialing software or other electronic credentialing systems is helpful but not required.
- Strong organizational and excellent follow-up skills.
- Ability to interact effectively with a variety of people (physicians and medical staff offices).
- Provide highest level of customer service for both internal and external customers.
- Strong written and verbal communication skills.
- Strong presentation and client interaction skills.
Brown University Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity, or expression, disability, protected veteran, or marital status.
