Credentialing Specialist

POSITION SUMMARY

Responsible for the credentialing of all clinical staff members, implementing necessary enrollment with commercial vendors, and performing other clerical tasks and special projects as needed.

Essential Position Duties

• Ensure provider credentialing applications are complete and accompanied with the appropriate requested documentation.
• Conduct verification of credentials for all licensed staff and contractual personnel including education, employment, National Practitioner Data Bank Query (NPDB), Office of Attorney General (OIG) Exclusion List, licenses, and American Medical Association (AMA) Physician Profile and/or Board Certification.
• Prepare and compile the necessary documentation and gather the appropriate signatures for initial appointment and reappointment of delineated privileges for presentation to the Staff Credentialing Committee.
• Ensure that the credentialing roster and provider carrier enrollment list are kept up to date on a daily basis.
• Coordinate and facilitate the new enrollment and maintenance of providers into Medicaid, Medicare, and commercial insurances.
• Send the updated provider carrier enrollment list to applicable staff on a weekly basis.
• Assist with the implementation and ongoing maintenance of the credentialing software.
• Maintain confidentiality of all credentialing data.
• Perform miscellaneous duties as required by management.
• Maintain appropriate attendance.

Compliance Responsibilities

• Comply with applicable legal requirements, standards, policies and procedures including but not limited to those within the Compliance Process, Code of Conduct, HIPAA and Corporate Integrity Agreement (CIA).
• Participate in required orientation and training programs, as required.
• Report concerns and suspected incidences of non-compliance in accordance with COHC Compliance Reporting Process.
• Cooperate with monitoring and audit functions and investigations.
• Participate, as requested, in process improvement responsibilities.

Core Competencies/Skill Sets

• Proficiency in Microsoft Office and Outlook is required.
• Excellent typing and interpersonal skills required.
• Strong organizational and excellent follow-up skills.
• Strong communication skills both verbally and in writing.
• Ability to interact professionally and communicate with coworkers, providers, and outside agencies.

Professional Experience/Educational Requirements

• High school diploma required, an Associate’s degree desirable.
• Minimum 1-2 years credentialing and/or privileging experience within a hospital or medical center environment is preferred.

Certification/Licensure

• Credentialing Specialist Certification preferred

COVID-19 VACCINATION REQUIREMENTS:

COHC requires all new employees to be vaccinated against Covid-19 prior to starting employment with COHC unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.