Job Description
Overview Position: Credentialing Specialist
Reports to: VP of Human Resources or Operations
SUMMARY Under general supervision, the Credentialing Specialist is responsible for a variety of tasks relating to healthcare provider credentialing. The Credentialing Specialist contacts providers and healthcare facilities to complete the credentialing process and maintain the status logs of applications. The Credentialing Specialist will be responsible for maintaining up-to-date provider files for all current and new providers according to the established departmental standards. This is not a remote position.
Responsibilities CHARACTERISTIC JOB TASKS AND RESPONSIBILITIES May include any and/or all of the following:
- Complete ALL provider and facility credentialing applications.
- Strong follow up with all submitted applications.
- Application and reapplication for provider's State and DEA licenses. Strong follow up.
- Maintain all renewal of licenses from our data base by sending out courtesy notifications of expiring licenses.
- Interact professionally with providers and ancillary staff to provide appropriate and timely responses.
- Verifications of providers' credentials using various websites and other forms of communication - state licenses, liability insurance, CDS and/or DEA certificates, education, hospital privileges, board certification, NPDB, OIG, etc.
- Maintain neat and accurate records utilizing applicable software.
- Maintain credentialing information by reviewing, entering, and following up on missing information.
- Stay up-to-date on industry trends and credentialing tools and resources
KNOWLEDGE, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS - Demonstrated ability to manage files or the collection and coordination of data
- General computer literacy skills and knowledge of Microsoft Office applications
- Utilize a high degree of independent decision-making regarding applicant credentials, skill level, and experience
- Maintain a focus on accuracy
- Ability to display professional interpersonal/human relations skills
- Ability to think strategically and prioritize the day-to-day tasks in an efficient manner
- Ability to maintain confidentiality
- Ability to be flexible and adapt in a fast-paced environment with providers starting on short notice
- Display a sense of motivation and initiative in all assigned duties and tasks
COMMUNICATION - Interact effectively and professionally with the LifeLinc team, management, facility administration, physicians, and other health care professionals
- Work with coworkers to obtain required information on a timely basis and to solve outstanding issues, as appropriate
- Promote and contribute positively to the teamwork of the department by assisting coworkers, contributing ideas, and problem-solving with colleagues
- Ability to effectively provide regular updates and requested reporting as needed
COMPLIANCE AND HIPAA - Ensures and adheres to strict confidentiality when handling patient information, according to the HIPAA Privacy Act and hospital policy and procedure regarding confidentiality
- Complies with all information security practices
- Has knowledge of and adheres to all compliance regulations, policies and procedures
- Completes annual Compliance and HIPAA exam
Qualifications REQUIRED & PREFERRED QUALIFICATIONS - High school diploma or equivalent required
- Two years of college experience preferred (emphasis on Business Administration or Healthcare Management)
- Three years of credentialing experience preferred, including experience with applying for provider licensure
- Experience using an online credentialing platform, preferably HealthStream/CredentialStream
PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to type and use a computer mouse; and talk or hear. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
Job Tags
Work at office, Flexible hours,