Provider Credentialing Specialist

7 days ago

Fort Mitchell, United States OrthoCincy Full time
Job Summary:

OrthoCincy is seeking a highly skilled Credentialing Manager to oversee and monitor the activities of the Credentialing Department. The successful candidate will be responsible for all aspects of the credentialing and privileging processes for all medical providers and payers to ensure excellent orthopaedic care in a patient-centered environment.

Key Responsibilities:
  • Department Oversight: Provide leadership and guidance to the Credentialing Department, ensuring efficient and effective operations.
  • Credentialing and Privileging: Manage the credentialing and privileging processes for all medical providers, including ensuring timely renewal of licenses and certifications.
  • Provider Management: Develop and maintain up-to-date information in CAQH/PECOS profiles for new and existing providers, and utilize software functions to convert paper documents to electronic files.
  • Contract Management: Initiate requests for new contracts with payers as needed, and maintain corporate provider contract files.
  • Quality Assurance: Audit health plan directories for current and accurate provider information, and maintain confidentiality of provider information.
  • Regulatory Compliance: Ensure adherence to HIPAA regulations and maintain knowledge of current health plan and agency requirements for credentialing providers.
Requirements:
  • Education: High School Diploma or equivalent, Associate's Degree preferred.
  • Certification and/or Licensure: Certified Provider Credentialing Specialist (CPCS) preferred, minimum two years relevant credentialing management experience.
  • Other Requirements: In-house, full-time position, with schedules subject to change as department needs dictate.

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