Credentialing Specialist
3 weeks ago
Description
Serve as the focal point of the credentialing process. Oversee the credentialing process, ensuring contracting providers maintain compliance with credentialing requirements. Ensure medical staff member maintains current credentials and licenses to work legally in their field or specialty. Monitor and track upcoming renewal dates and work with medical staff to advise them of the required steps to maintain their credentials. Responsible for day-to-day credentialing services tasks, to include payor enrollment, revalidations and other tasks required by payors. Serve as the initial point of contact for contracted payors, insurances, and other related entities. Assist with policy and procedure interpretation.
Duties and Responsibilities
Work with contracted providers to meet all the 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 renew by dates. Oversee the credentialing process Complete the processes to enroll and credential providers (e.g., physicians, facilities, physician assistants, nurse practitioners, etc.) 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. RequirementsMinimum Education and Experience
High school degree or equivalent, required 5 years of provider enrollment credentialing or similar experience, requiredPreferred Education and Experience
Associate degree in business or healthcare related field (Will consider a combination of applicable experience and education.) Certified Provider Credentialing Specialist (CPCS) preferredSkills 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 judgement Ability to collect data, interpret findings, and carry out established plan Ability to handle pressure effectively.Pay: From $20.00 per hour
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