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Credentialing Specialist
2 months ago
Provident Practice Management Services, LLC is seeking a highly skilled Credentialing Specialist to join our team.
Job SummaryThe Credentialing Specialist will be responsible for maintaining accurate and up-to-date credentialing information for our healthcare providers. This includes processing applications for new and renewed state medical licenses, enrolling providers in health plans, and credentialing providers with affiliated health plans.
Key Responsibilities- Process applications for new and renewed state medical licenses, ensuring files are updated and complete.
- Enroll new providers in health plans and process re-enrollments as needed.
- Credential all providers with affiliated health plans.
- Obtain and process applications for hospital privileges for all Medical Physicians.
- Notify schedulers, clinic managers, and doctors of physicians' enrollments in health plans.
- Update and assist the ASC administrator with maintenance of ASC provider files.
- Track Provider CME credits earned and stay informed of state CME requirements.
- Complete compliance training requested by the company and required by law.
- Adhere to HIPAA compliance plan.
- Communicate internally with all ESG/PASCH/PPMS staff.
- Communicate externally with MetroCare, State Boards, etc.
Education/Training:
High school diploma or general education degree (GED); OR six months credentialing experience and/or training; OR equivalent combination of education and experience.
Skills:
- Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
- Ability to write reports, business correspondence, and procedure manuals.
- Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
- Demonstrated excellence in verbal communication, as well as, written communication.
- Good interpersonal and customer service skills.
- Critical thinking skills for identifying problems and resolutions in a fast-paced environment.
- Ability to calculate figures and amounts such as discounts, interest, commissions, percentages, area, circumference, and volume.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Ability to interpret an extensive variety of technical or complex instructions and deal with several abstract and concrete variables.
- Proficient in common business software; EMR preferred.
- Keyboard skills.
Attributes:
- Represents the practice in a positive and professional manner.
- Punctual.
- Team player; willingness to help other staff.
- Attention to detail while multi-tasking.
- Diplomacy and confidentiality with patients and staff.
- Strong work ethic.
- Initiative/Self-Motivation.
