Description

Responsible for all aspects of the credentialing and re-credentialing processes for all medical, dental, and mental health providers who provide patient care at Heritage Health. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

Requirements

• High school diploma or equivalent. 
• Two years of relevant credentialing experience.
• Certified Provider Credentialing Specialist (CPCS) preferred. 
• Proven ability to handle confidential information and work with minimal supervision. 

Knowledge, Skills, and Abilities Required:

1. Knowledge and understanding of the credentialing process.
2. Proficient computer skills for word processing and spreadsheets.
3. Ability to speak and write effectively and to analyze, edit, review and interpret complex material.
4. Thorough knowledge of office technology and business terminology, equipment and procedures.
5. Ability to maintain cooperative working relationships with other departments and organizations.
6. Ability to work independently.
7. Be service-oriented with the ability to pay attention to details in a fast-paced environment.

Duties and Responsibilities:

1. Compiles and maintains current and accurate data for all providers.
2. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
3. Completes location credentialing and re-credentialing applications; monitors applications and follows-up as needed.
4. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
5. Maintains knowledge of current health plan and agency requirements for credentialing providers.
6. Sets up and maintains provider information in online credentialing databases and system.
7. Tracks license and certification expirations for all providers to ensure timely renewals.
8. Ensures practice addresses are current with health plans, agencies and other entities.
9. Tracks license, DEA and professional liability expirations for appointed ASC providers.
10. Audits health plan directories for current and accurate provider information.
11. Regular and predictable attendance is an essential function of this position.
12. Responsible for overseeing credentialing of all providers and staff, ensuring compliance.
13. Performs other duties as assigned.