Credentialing Specialist

Position Title: Credentialing Specialist

Supervisor: COO/CFO

FLSA Status: Non-Exempt

Mission

To provide our patients and community with the most innovative and breakthrough treatment options to improve overall health and wellness.

Values

• Patient Experience
• Innovation
• Integrity
• Teamwork
  
  

Job Summary

The Credentialing Specialist role is responsible for all aspects of the privileging and credentialing process for all licensed providers and facilities payors. This role will oversee streamlining, communicating, and facilitating the onboarding and offboarding process for medical professionals and will assist in credentialing and re-credentialing providers with health plans, hospitals, state and federal, and facility licensure tasks. Responsibilities of this role include, but are not limited to:

• Manage the credentialing and credentialing process for all medical providers for all Clinics and Ambulatory Surgery Centers. Serve as the point of contact for the providers and answer any questions about the credentialing/ privileging process.
• Track and maintain up-to-date database of provider credentials, licenses, certifications, training, immunizations, affiliations, DEA’s, etc. Ensure compliance with current local, state, and national/federal policies.
• Assist providers in enrolling with various insurance networks and health plans.
• Verify liability and eligibility of medical professionals as well as the authenticity of documents submitted by providers for credentialing.
• Ensure compliance with state and federal regulations regarding provider credentialing, privileging, and licensing.
• Communicate and collaborate with various departments to facilitate smooth onboarding, credentialing, privileging, and reappointment of providers.
• Assist in developing, preparing, and updating credentialing applications, procedures, and policies. Submit necessary credentialing applications and information to process internal and external (hospital, payor) privileges or affiliations.
• Adhere to company policies regarding security and confidentiality. Maintain confidential records and data, including but not limited to sensitive security information, personnel contact information, background check information, and employer information.
• Other duties as assigned.
  
  

Supervisory Responsibility

• There are no supervisory responsibilities associated with this role.
• Associate’s or Bachelor’s degree required.
• Prior experience in Payor/Provider credentialing required.
  
  

Qualifications

Skills & Abilities:

• Highly self-motivated and able to work with minimal supervision.
• Excellent verbal and written communication skills; interpersonal, customer service, and telephone etiquette skills.
• Proficient in a variety of computer and web-based programs.
• Excellent attention to timeliness, detail, and accuracy.
• Exceptional organizational skills and ability to multitask.
• Highly focused and possess a strong work ethic.
• Knowledge of medical credentialing and privileging procedures and standards.
• Ability to handle confidential information in a professional manner through knowledge of compliance with state and federal laws, including HIPAA.
  
  

Work Environment

While performing the duties of this job, the employee regularly works in a medical surgery center and office setting.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to grasp, handle, or feel objects, tools, or controls; reach with hands and arms; balance; stoop, kneel, crouch; talk, hear, and smell. The employee must be able to lift or move up to 30 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Compensation & Work Schedule

• Part Time: 20 hours/week
• Non-Exempt.
• Day Shift: Monday – Friday. A competitive benefits package including medical, dental, vision, disability and life insurance, 401(k) plan, PTO time, paid holidays, and HSA plan is offered.
  
  

JOB CODE: 1000125