Credentialing Specialist, Full Time

Description

Responsible for all aspects of the credentialing and recredentialing processes for payer enrollment and hospital privileging. Responsible for ensuring all providers are credentialed, and enrolled in accordance with established accreditation, regulatory and policy requirements. Maintain up-to-date data for each provider in credentialing databases and online systems.

Shift: M-F, 8:30 AM - 5:00 PM

Requirements

Essential Duties and Responsibilities:

• Completes provider and facility payer enrollment applications; monitors applications to ensure timely start dates and no lapses in enrollment. 
• Maintains copies and tracks current state licenses, DEA certificates, malpractice coverage, accreditation, and any other required credentialing documents for all providers and facilities. 
• Compiles and maintains current and accurate data for all providers and facilities using the credentialing software. 
• Maintains knowledge of current accreditation, regulatory and policy requirements. 
• Other duties or projects assigned. 

Education/Licensing/Certification:

Associate degree or an appropriate combination of education and work experience preferred. 

Certified Provider Credentialing Specialist (CPCS) preferred.

Experience (years and type): 

• A minimum of three years of relevant credentialing, enrollment, and/or billing experience.
• Payer Enrollment experience preferred. 
• Practitioner Hospital Privileging required MD Staff software experience preferred. 
• Practitioner Licensing experience preferred 
• CAQH experience preferred.

Knowledge and Skills:

• Knowledge and understanding of the credentialing and enrollment process. 
• Ability to organize and prioritize work and manage multiple priorities. 
• Excellent verbal and written communication skills 
• Excellent attention to detail 
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. 
• Proficient use of Microsoft Office applications (Word, Excel, SharePoint) and credentialing software