Credentialing Specialist

Description

CPIhealth is a multidisciplinary team dedicated to providing compassionate and comprehensive care to individuals experiencing chronic pain. With state-of-the-art facilities, advanced technology, and a collaborative environment, we offer a platform for healthcare providers to excel in their specialties while making a profound difference in the lives of those we serve.

As you consider your next career move, we invite you to join us in redefining pain management through innovation, expertise, and a commitment to improving patient outcomes. Together, we can shape the future of healthcare and positively impact countless lives.

The Credentialing Specialist ensures that all providers are appropriately credentialed and privileged with government payers and insurance carriers. This role coordinates credential verification and analysis to support provider appointments, reappointments, and other credentialing activities for the medical staff of ambulatory surgical centers and hospitals.

 Website: https://capitolpain.com 

Essential Functions

• Documents all work performed for credentialing events in database as part of the communication with internal customers; maintains credentialing database according to department policies and procedures and regulatory guidelines. 
• Completes initial and re-credentialing applications with all payers and communicates the progress, completion and findings of ongoing applications. 
• Identifies and resolves issues of concern including providers’ enrollment with payers and takes appropriate action as needed. 
• Obtain privileging and maintain re-privileging of providers with ASCs and hospitals.
• Renews all licenses and certifications of providers; maintains provider files on government websites and CAQH, as required.
• Responsible for investigation and documentation of practitioner credentials, utilizing specialized knowledge to obtain verification of all aspects of a practitioner's background, training and past practice.
• Understands credentialing requirements of both The Joint Commission and NCQA, CMS and other State governmental requirements, and performs in accordance with these standards. 
• Generates and maintains accurate documentation that may be reviewed and judged for acceptability by state and federal licensing agencies, external and internal customers. 

Requirements

• High School diploma or equivalent. Bachelor’s degree in healthcare, business or related field, preferred. 
• Medical office or prior credentialing experience preferred.
• Strong customer and physician relations skills. Demonstrated effective interpersonal skills.
• Excellent organizational and communication skills to provide excellent customer service. 
• Proficient in the use of Microsoft Office (Excel and Word) or similar products. 
• Ability to work in a team environment or independently with minimal supervision while managing multiple priorities. 
• Critical thinking, judgment, detail analysis and problem solving skills. 
• Knowledge of basic medical terminology.  Prefer familiarity with credentialing requirements of both The Joint Commission and NCQA, CMS and other State governmental requirements.
• Ability to maintain a high level of confidentiality.
• Ability to multi-task and perform multiple priorities.  
• Meet internal and external deadlines and produce a consistently high-quality product.

Comprehensive Benefits plan including:

• Medical, Dental, Vision insurance

• Paid Time Off (accrued)

• Flexible Spending Account for Health & Dependent Care

• Basic Life, Accidental Life, Supplemental Life Insurance

• Short Term & Long-Term Disability

• 401(k) with matching