Job Description

Responsible for provider onboarding, startup and tracking of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care. Responsible for ensuring providers are credentials, appointed, and privilege with health plans, hospitals and patient care facilities. Collaborates with Care Management, Third Party Payors, Providers and other departments to provide rapid and thorough identification, investigation and resolution of member, practitioner and provider quality related issues. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

SHIFT AND SCHEDULEM-F 8:00 AM - 5:00 PM 

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS• Perform all duties in accordance with established policies and procedures• Excellent organizational skills including the ability to handle multiple projects and timelines with minimal supervision required.• Ability to identify, assess and resolve highly complex problems relating to Provider onboarding.• Compiles and maintains current and accurate data for all providers.• Completes provider credentialing and re-credentialing applications; monitors applications and follows up as needed. Tracks license and certification expirations for all providers to ensure timely renewals.• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.• Maintains corporate provider contract files• Maintains knowledge of current health plan and agency requirements for credentialing providers to include PriMed and MHP.• Ensures practice addresses are current with health plans, agencies and other entities• Processes applications for appointment and reappointment of privileges to area hospitals• Audits health plan directories for current and accurate provider information• Enhances operational effectiveness, and assist in providing high-quality patient care.• Ability to organize and prioritize work and manage multiple priorities• Establish and maintain effective working relationships with provider, management, Midland Health staff, and contacts outside the organization• Excellent attention to detail• Excellent verbal and written communication skills. • Prepares special reports, statistics, data analysis related to operations as required by the Executive Director.• Knowledge of Microsoft Word and Excel.• Maintains strictest confidentiality. Maintains confidentiality of provider information.• All other duties as assigned.

EDUCATION AND EXPERIENCE• Bachelor degree in health or business administration or 5 years of experience in Health Care. • Certified Provider Credentialing Specialist (CPCS) preferred or a least two years of relevant credentialing experience.

PHYSICAL REQUIREMENTS

· To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

· Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.