Credentialing Specialist

3 weeks ago


Charleston, South Carolina, United States FETTER HEALTH CARE NETWORK INC Full time
Job Description

The Credentialing Specialist plays a vital role in ensuring the compliance of FHCN providers with regulatory requirements. This position is responsible for maintaining the confidentiality and accuracy of credentialing documentation, including provider files. The Credentialing Specialist must ensure that providers adhere to credentialing standards set by the agency.

Key Responsibilities:

  • Completes insurance credentialing and re-credentialing applications for FHCN providers with various insurance vendors, Medicare, and Medicaid, and monitors applications as needed.
  • Maintains current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.
  • Compiles and maintains current and accurate data for provider contract files.
  • Stays up-to-date with current health plan and agency requirements for credentialing providers.
  • Sets up and maintains provider information in online credentialing databases and systems.
  • Tracks license and certification expirations for all providers to ensure timely renewals.
  • Ensures practice addresses are current with health plans, agencies, and other entities.
  • Processes applications for appointment and reappointment of privileges to FHCN.
  • Tracks license, DEA, and professional liability expirations for appointed FHCN providers.
  • Maintains FHCN appointment files and information in credentialing databases.
  • Audits health plan directories for current and accurate provider information.
  • Ensures compliance with FHCN credentialing policy.

Requirements:

  • Knowledge and understanding of the credentialing process.
  • Ability to organize and prioritize work and manage multiple priorities.
  • Excellent verbal and written communication skills.
  • Excellent attention to detail.
  • Ability to research and analyze data.
  • Ability to work independently with minimal supervision.
  • Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
  • Proficient use of Microsoft Office applications (Word, Excel) and internet resources.

Education and Experience:

  • At least two years of relevant credentialing experience, preferably in the healthcare industry.
  • Bachelor's degree in Business Administration or related field of study.
  • Master's degree in Human Resources, Business, or related field (preferred).
  • Certified Provider Credentialing Specialist (CPCS) (preferred).

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