Medical/Physician Credentialing Specialist

 

 

 

 

The Medical/Physician Credentialing Specialist position performs credentialing activities of the organization and medical staff in compliance with all internal requirements (bylaws, rules and regulations, policies and procedures) and external accreditation standards (The Joint Commission), state laws and CMS Conditions of Participation. The Credentialing Specialist also provides support and administrative assistance to the Contracts department. This position requires attention to detail, high levels of organizational skills, discretion and confidentiality, timeliness, efficiency, and the ability to interact with internal and external partners in a professional manner.  Key characteristics of the role include organizational credentialing, database management, and project management. This position reports to the Chief Financial Officer.

 

 

·        Must possess a high school diploma, Associate Degree preferred. 

·        Minimum of 2 years work experience with medical administration for a healthcare organization or as a Credentialing Specialist.

·        Proficient in Microsoft Office, intermediate proficiency in Excel and Outlook.

·        Highly organized and detail oriented to support the many deadlines and organizational requirements.

·        Excellent written and verbal communication skills.

·        Ability to function independently and effectively in a self-directed environment

 

 

·        Facility (medical) credentialing 

·        Process credentialing and re-credentialing applications for all practitioners & payers, including conducting primary source verification, collecting, and validating documents to ensure the accuracy of all credentialing.

·        Application management for billing enrollment and timely reimbursement.

·        Maintain all provider applications on CAQH & Availity, while continuously evaluating applications for completeness.

·        Management of expirable documents on file, electronically and paper copy as appropriate.

·        Management of internal provider credentialing database.

·        Act as a liaison with regulatory agencies.

·        Assist in process improvement of credentialing process.

·        Maintains contract database and generates reports summarizing key information for the organization and senior leadership.

·        Provides support for the contracting and renewal process and monitors for upcoming contract renewals. 

·        Monitors all contract files and performs internal audits to ensure documentation is not missing or outdated (certificates of insurance, OIG’s, etc.).

·        Other special projects/assignments assigned as needed.

 

·        Multi-task and prioritize in a changing environment.

·        Attention to detail and accuracy, focused and organized, and ability to meet deadlines.  

·        Comfortable with computers and proficiency in relevant organization software and Microsoft Office. 

·        Uses multiple communication strategies to enhance communication in the organization and team.

·        Ability to work in a confidential manner, ensuring information is shared with internal and external individuals in an appropriate manner.

·        Professional with good communication and customer service initiative.