Credentialing Specialist

Summary

The Credentialing Specialist is responsible for the coordination of all medical staff’s (practitioner/provider) credentialing and re-credentialing process, from application through completion. This will include managing the credentialing for State licensing and all hospital and facility credentialing processes. The Credentialing Coordinator will also assist and oversee the functions and tasks related to government and commercial payors credentialing.

Responsibilities

• Responsible for the quality, accuracy and timeliness of the credentialing verification process for new physicians and medical assistants.
• Work with multiple hospitals and providers via phone and e-mail to obtain applications and documents and assist in the credentialing process;
• Prepares and submits hospital credentialing and re-credentialing applications
• Oversees updating of credentialing files and tracking tools with current information
• Manages, plans, coordinates and implements the reappointment processes for all medical staff.
• Data entry, documentation and tracking of all steps taken, including, provider numbers, effective dates, and correspondence received, following credentialing task list.
• Responsible for completing all Credentialing tasks within on-boarding checklist.
• Monthly monitoring and updating of expired documents.
• Physician/Client/Internal communication,
• Populate applications and documents with physician specific information as needed,
• Timely follow-up on pending credentialing issues;
• Other duties as assigned.

Other Functions

• Basic clerical functions including computer skills, faxing, copying and filing.
• Assists in maintaining and distributing physician schedule,
• Assists other areas as needed.

Communication

• Internal: Physicians, clinical and non-clinical employees of HOA
• External: Hospitals, providers, government, commercial payors, etc.

Physical Requirements/Environment

No exposure to extreme heat, cold or electrical components; position is primarily sedentary and requires repetitive motion associated with computer data entry; occasionally lifting of boxes up to 25 lbs. may be required. Requires ability to read, write, hear, speak and understand English.

Educational/Training Requirements

Two years previous credentialing experience preferred,

Knowledge of NCQA and TJC credentialing standards preferred,

Strong communications skills, both written and verbal,

Must have strong interpersonal skills and ability to work well with individuals at all levels within practice,

Strong organizational skills; detail oriented;

Ability to develop and maintain paper and on-line filing systems;

Must work efficiently under deadlines,

Strong computer skills to include Word, Excel and Outlook.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification; they are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.