Credentialing Specialist

2 weeks ago


Kansas City, Missouri, United States Swope Health Services Full time

The Credentialing Specialist plays a vital role in ensuring the highest quality provider network for Swope Health Services. This position is responsible for developing and implementing processes, procedures, and policies in accordance with HRSA, Joint Commission, and other grant makers' standards.

Key Responsibilities:
  • Develop and implement centralized credentialing and privileging processes and procedures for Swope practitioners.
  • Prepare credentialing and privileging documents for initial appointments and reappointments in a timely and complete manner.
  • Work closely with physicians, mid-levels, licensed independent practitioners, and other licensed or certified practitioners to acquire necessary materials and information for enrollment with commercial insurance plans.
  • Ensure compliance with HRSA, JCAHO, and other grant makers' or certification standards for credentialing and privileging of various practitioner types.
  • Use credentialing software proficiently and add credentialing information to the HR associate record as necessary.
  • Coordinate with various departments to ensure communication of completed credentialing and privileging requirements to ensure appropriate billing for services.
  • Convene monthly Credentialing Committee meetings, prepare agenda, and records, and ensure the decisions of the committee are acted upon.
Requirements:
  • Associate degree in business administration or equivalent experience, bachelor's degree preferred.
  • 1-5 years credentialing experience or relevant work experience required.
  • Certified Provider Credentialing Specialist certification preferred.
About Swope Health Services:

Swope Health Services is a leading healthcare provider that serves over 45,000 patients annually. Our team members are dedicated to delivering coordinated care that values the needs of the whole person and championing better health in our community.

Benefits:
  • Medical benefits (including a Health Savings Account option), dental, and vision.
  • 401(k) retirement plan with company match.
  • Company-paid benefits such as life insurance, Accidental Death & Dismemberment, and Short- and Long-Term Disability.
  • Flexible Spending Account.
  • Paid Days Off beginning at 12 days annually, effective the first day of employment.
  • Eight annual company-paid holidays; One annual paid personal day.


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