Credentialing Specialist

Credentialing Specialist

Requirements

• Knowledge of provider licensure/malpractice information.
• Knowledge and experience with the Curriculum Vitae structure and Content.
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Ability to work independently and manage deadlines.
• Able to handle multi-tasking processes.
• Ability to prioritize work environment.
• Act as team player: collaborate, communicate clearly, and cooperate with team members.
• Ability to meet standard production requirements.
• Skill in using computer programs and applications including Microsoft Office.
• Complies with HIPAA regulations for patient confidentiality.

Responsibilities

• Is responsible for full application process of physicians within the Practice in all plans as directed by Administration.
• Develops and maintains central physician files with appropriate filing information needed.
• Maintains these files within the confidentiality policy of the Practice.
• Is responsible for the notification of any licensing and monitoring to insure timely renewal.
• Communicates any deficient areas of information, timeliness, and/or problems that could affect the reimbursement for services performed.
• Works with the Chief Administrative Officers and Billing Office Managers to ensure that all providers are in all existing managed care plans and completes submission of all physicians into newly negotiated plans.
• Responds to all inquiries regarding the credentialing, licensing, and renewal processes.
• Maintains activity log during the credentialing process to ensure a timely conclusion.
• Is responsible for notification of approval of all credentialing to the various departments within the Practice.
• Is responsible for meeting the production and quality standards as set for this position.
• Participates in educational activities.
• Enhances communications by consistently displaying excellent customer service skills in behavior and attitude.
• Performs other position related duties as assigned.
• Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations.

Preferred Qualifications

No preferred qualifications provided.