Credentialing Specialist

4 weeks ago


Providence, Rhode Island, United States Lifespan Full time
Job Summary

Under the general supervision of the Credentialing Manager, this role performs a variety of clerical and administrative functions to provide support and assistance in day-to-day activities of the Patient Financial Service Credentialing Department.

Key Responsibilities
  • Receives and audits incoming requests for enrollment and provider documentation.
  • Answers phone calls from providers, practice managers, directors, and health plans.
  • Handles and resolves provider/practice manager complaints and inquiries via email or phone.
  • Processes customer and account source documents by reviewing data for deficiencies and resolving discrepancies.
  • Prepares source data for database entry by compiling and sorting information and establishing entry priorities.
  • Enters provider data in the credentialing database and verifies entered customer and account data.
  • Maintains provider records in the credentialing database and reports needed changes for process improvement.
  • Maintains customer confidence and protects operations by keeping information confidential.
  • Maintains productivity measures and quality measures as defined by the Credentialing Department.
  • Contributes to team effort by accomplishing related results as needed.
Requirements
  • High school level of knowledge or equivalent required; associate degree preferred.
  • Minimum one to two years credentialing and/or privileging experience within a hospital or managed care environment.
  • Must have at least one-year of experience in a healthcare office environment.
  • Proven expertise in the healthcare physician credentialing, expirables management, re-credentialing, and provider enrollment environment.
  • Strong organizational and excellent follow-up skills.
  • Ability to interact effectively with a variety of people (physicians and medical staff offices).
  • Provide highest level of customer service for both internal and external customers.


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