Credentialing Specialist

2 weeks ago


Philadelphia, Pennsylvania, United States Resources For Human Development Full time

Job Type

Full-time

Position Title

Credentialing Specialist

Reports to

Director of Financial Operations

Organizational Overview

Resources for Human Development is dedicated to providing comprehensive support services that enhance the quality of life for individuals and families. We believe in the importance of accessible, high-quality care delivered with compassion and respect for the diverse needs of our community. Our mission is to empower individuals through integrated services that promote health, well-being, and resilience.

Position Overview

The Credentialing Specialist plays a crucial role in managing the credentialing and privileging processes for all providers within the organization. This position is responsible for processing applications, verifying credentials, and ensuring compliance with relevant standards and regulations. The Specialist will maintain the integrity of credentialing data and support the organization’s ability to deliver exceptional healthcare services.

Key Responsibilities

1. Conduct thorough and timely verification of information submitted by healthcare providers, maintaining confidentiality of credentialing files.

2. Ensure completion of all credentialing tasks for new hires in accordance with established protocols.

3. Collaborate with Human Resources to enhance the onboarding experience for new staff.

4. Develop and manage clinician applications for various payers.

5. Process initial and ongoing credentialing applications for both billable and non-billable medical staff.

6. Maintain compliance with documentation standards for all credentialing requirements, including licenses and certifications.

7. Track and store current credentialing documents, performing primary verifications as necessary.

8. Input and update provider credentials and privileging information in the credentialing database.

9. Monitor Medicare exclusion checks for all staff members.

10. Prepare and present monthly credentialing and enrollment reports to relevant departments.

11. Oversee any outsourced credentialing services and vendors.

12. Manage credentialing software and systems, assisting in the selection of tools as needed.

13. Liaise with the Revenue Cycle Team to ensure effective communication regarding credentialing matters.

14. Perform additional duties as assigned.

Qualifications

- Preferred certification as a Certified Professional Credentialing Coordinator (CPCS) or Certified Medical Staff Coordinator (CMCS) by the National Association of Medical Staff Services (NAMSS).
- Proficient in Microsoft Office Suite and other credentialing software applications.
- Associate's degree or equivalent experience.

Physical Requirements

- Ability to exert up to 20 pounds of force frequently and perform various physical activities including standing, walking, and using hands for tasks.

Equal Opportunity Employment

Resources for Human Development is an equal opportunity employer. We welcome applications from all qualified individuals without regard to race, color, age, religion, gender, gender identity, sexual orientation, national origin, genetic information, veteran, or disability status.

Visa Sponsorship

Resources for Human Development does not provide H1B Visa Sponsorship. All candidates must be authorized to work in the United States without sponsorship.

Commitment to Diversity

We are committed to fostering an inclusive environment that supports diversity and equity within our organization and the communities we serve.



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