Credentialing Specialist

7 days ago

Baton Rouge, Louisiana, United States Premier Health Consultants Full time
Credentialing Specialist Job Description

Premier Health Consultants is seeking a highly skilled Credentialing Specialist to join our team. As a Credentialing Specialist, you will be responsible for managing all aspects of the credentialing and recredentialing processes for medical providers working in our clinics.

Key Responsibilities:
  • Process initial credentialing and recredentialing applications for medical providers.
  • Screen practitioners' applications and supporting documentation to ensure eligibility.
  • Collect and verify information from various sources, including the National Practitioner Data Bank (NPDB), applicant, and malpractice insurer.
  • Identify discrepancies in information and conduct follow-up investigations.
  • Present applications to the Credentialing Committee for review and approval.
  • Assist with credentialing inquiries and respond to health plan provider inquiries.
  • Capture primary source documentation in computer databases and ensure data accuracy and integrity.
  • Ensure compliance with applicable laws, regulations, and policies.
Requirements:
  • High School Graduate or specialized training combined with 3+ years of experience in office operations.
  • 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.
Competencies:
  • Technical Skills: Strives to continuously build knowledge and skills; shares expertise with others.
  • Customer Service: Responds promptly to customer needs.
  • Interpersonal Skills: Maintains confidentiality.
  • Oral Communication: Responds well to questions; participates in meetings.
  • Written Communication: Presents numerical data effectively.
  • Teamwork: Balances team and individual responsibilities; contributes to building a positive team spirit.
  • Quality Management: Demonstrates accuracy and thoroughness.
  • Business Acumen: Understands business implications of decisions; displays orientation to profitability.
  • Cost Consciousness: Works within approved budget; develops and implements cost-saving measures; contributes to profits and revenue; conserves organizational resources.
  • Diversity: Promotes a harassment-free environment.
  • Ethics: Keeps commitments; works with integrity and ethically; upholds organizational values.
  • Organizational Support: Follows policies and procedures.
  • Judgment: Exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process; makes timely decisions.
  • Motivation: Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles.
  • Planning/Organizing: Prioritizes and plans work activities; uses time efficiently; organizes or schedules other people and their tasks.
  • Professionalism: Reacts well under pressure; accepts responsibility for own actions; follows through on commitments.
  • Quality: Monitors own work to ensure quality.
  • Adaptability: Changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.
  • Dependability: Keeps commitments; commits to long hours of work when necessary to reach goals.

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