Credentialing Specialist

Employment Type

: Full-Time

Industry

: Miscellaneous



ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
1. Compiles and maintains current and accurate data for all providers.
2. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
3. Maintains copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.
4. Maintains corporate provider contract files.
5. Maintains knowledge of current health plans and agency requirements for credentialing providers.
6. Sets up and maintains provider information in online credentialing databases and systems.
7. Tracks license and certification expirations for all providers to ensure timely renewals.
8. Ensures practice addresses are current with health plans, agencies, and other entities.
9. Processes applications for appointment and reappointment of privileges to The Doctors Clinic (ASC).
10. Tracks license, DEA, and professional liability expirations for appointed ASC providers.
11. Maintains ASC appointment files, and information in the credentialing database.
12. Audits health plan directories for current and accurate provider information.

ADDITIONAL RESPONSIBILITIES:
1. Maintains confidentiality of provider information.
2. Provides credentialing and privileging verifications.
3. Performs other duties as assigned.

QUALIFICATIONS:
Education:
1. High school diploma or equivalent. / Associate degree preferred.

Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.

Experience: Two years of relevant credentialing experience

Credentialing Specialist Skills:

1. Knowledge and understanding of the credentialing process.
2. Ability to organize and prioritize work and manage multiple priorities.
3. Excellent verbal and written communication skills including, letters, memos and emails.
4. Excellent attention to detail.
5. Ability to research and analyze data.
6. Ability to work independently with minimal supervision.
7. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
8. Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.


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