Credentialing Specialist

2 days ago

MagstattleBas, Grand Est, United States Community Health Development Partners Full time
{"title": "Credentialing Specialist", "description": "Job Summary

We are seeking a skilled Credentialing Specialist to join our team at Community Health Development Partners. As a key member of our healthcare team, you will be responsible for overseeing the credentialing process, ensuring that contracting providers maintain compliance with credentialing requirements. Your attention to detail and organizational skills will be essential in managing the day-to-day credentialing services tasks, including payor enrollment, revalidations, and other tasks required by payors.

Key Responsibilities
  • Work with contracted providers to meet all credentialing service expectations outlined in their agreements.
  • Review and screen initial and re-appointment credentialing applications for completeness, accuracy, and compliance with Federal, state, local, and University regulations, guidelines, policies, and standards.
  • Create and maintain licensing, credentials, and insurance records.
  • Monitor license and credential expiration dates and advise staff members of required renewal dates.
  • Oversee the credentialing process and complete the processes to enroll and credential providers with insurances, while meeting payor criteria.
  • Complete the processes to re-credential existing providers.
  • Gather and maintain current data and documents for all providers in an organized and complete way.
  • Follow up with clients and insurances for timely credentialing process(es).
  • Clearly and effectively communicate with providers, Operations Managers, and insurance companies handling basic questions dealing with the day-to-day operation of credentialing and payor enrollments.
  • Review and update, if necessary, health plan directories, agencies, and other appropriate entities for current and accurate provider information.
  • Monitor files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
  • Respond to emails timely and effectively.
  • Must maintain professional appearance and demeanor at all times.
  • Other duties as assigned.
Requirements
  • High school degree or equivalent, required.
  • 5 years of provider enrollment credentialing or similar experience, required.
Preferred Qualifications
  • Associate degree in business or healthcare-related field (Will consider a combination of applicable experience and education).
  • Certified Provider Credentialing Specialist (CPCS) preferred.
Skills and Abilities
  • Attention to detail.
  • Excellent organizational skills, with ability to prioritize assigned projects and tasks.
  • Strong analytic and problem-solving abilities.
  • Excellent verbal and written communication skills.
  • Ability to read, write, and utilize manual and computerized systems of documentation.
  • Excellent computer literacy and skills, with proficiency in the use of Microsoft Excel, Word, PowerPoint, and Outlook, as well as the ability to industry-specific software application.
  • Commitment to maintaining confidentiality and discretion in all communications.
  • Ability to work independently and use independent judgment.
  • Ability to collect data, interpret findings, and carry out established plan.
  • Ability to handle pressure effectively.
Pay and Benefits

From $20.00 per hour.

", "lang_code": "en"}

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