JOB TITLE: CREDENTIALING SPECIALIST

REPORTS TO: Manager, Revenue Cycle

JOB DESCRIPTION: Under minimal supervision, perform daily functions of the credentialing and recredentialing process by processing applications for Physicians. Credential providers according to all credentialing policies & procedures and Federal & State regulatory requirements. Act as liaison between the Credentialing department and all Premier facilities.

DUTIES AND RESPONSIBILITIES:

1. Complete all applications in accordance with government and payor standards and submit applications within the required reporting period.

2. Gather and obtain all appropriate documentation for facilities and physicians’ payor enrollment.

3. Perform necessary follow-up with each Contractor and respond to all inquiries or requests with the allotted timeframe.

4. Communicate effectively with the facility Managers, Payors, and Physicians.

5. Research facility or physician enrollment and credentialing related issues. Work with the staff to adhere to new policies as well as communicate necessary changes as impacted by regulations (CME’s, Licensures, etc.).

6. Oversee credentialing process by notifying Credentialing Verification Organization (CVO) and Payors of new and terminated providers and of any changes.

7. Complete Payor facility credentialing applications.

8. Maintain accurate credentialing files for physicians, physician assistants and all allied health professionals, i.e. licenses, DEA, CV, Malpractice Certificates, Business Licenses, and liability certificates.

9. Review and enter physician logs into database.

10. Serve as liaison between Credentialing Department and all other facilities to assist with education of and compliance with Medical Staff Bylaws.

11. Assist in performing internal compliance investigations and audits throughout the organization, including compiling detailed reports with recommendations to the Compliance Officer and management.

12. Assist in performing ongoing compliance training throughout the organization.

13. Provide ongoing advice and resources to management for compliance issues and process monitoring and improvement, and work with management to implement these improvements.

14. Assist with contract negotiations and special projects as needed.

The job holder must demonstrate current competencies applicable to job position.

REQUIREMENTS

LICENSE/CERTIFICATION: None.

EDUCATION: Bachelor’s degree in healthcare administration or business administration preferred.

EXPERIENCE: At least three years credentialing/compliance experience in a healthcare setting.

KNOWLEDGE:

1. Knowledge of credentialing policies and procedures.

2. Knowledge of government application filing.

3. Knowledge of record-keeping practices.

4. Knowledge of customer service principles and techniques.

SKILLS:

1. Skill in using word processing, spreadsheet and database management.

2. Skill in communicating clearly and concisely.

3. Skill in handling confidential information.

4. Ability to analyze, extract and interpret government enrollment and billing regulations.

5. Skill in understanding of practice compliance regulations.

ABILITIES:

1. Ability to work effectively with all levels of personnel including physicians, managers and other staff.

2. Ability to be highly efficient, organized and accurate in work.

3. Ability to plan, prioritize, and complete tasks.

4. Ability to handle sensitive and confidential information.

PHYSICAL/MENTAL: Sitting 6-8 hours/day. Occasional stress from dealing with deadlines. Requires use of computer and office equipment.

ENVIRONMENTAL/WORKING CONDITIONS: Office setting. Frequent contact with staff, public and physicians.

Equipment/Tools or special clothing required to perform the job:

1. Office Equipment (computer, fax machine, copier)

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

Job Type: Full-time

Pay: From $38,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift

Experience:

• Credentialing: 1 year (Preferred)

Work Location: In person

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