Position Summary:

The Credentialing Specialist is responsible for assisting the St. Croix Hospice Legal Department in maintaining active enrollment status for the organization and all providers by successfully completing initial and subsequent credentialing packages as required by commercial payers, Medicare, and Medicaid.

Responsibilities:

• Initiate and support the credentialing process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for the credentials verification process
• Monitor expiring licensure, board and professional certifications, and other expirable documents for the organization and associated practitioners within the prescribed timeframe
• Maintains internal systems for tracking all provider licenses and related regulatory information
• Completes follow-up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process
• Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance Support regulatory questions and requests from various branches and leaders throughout the organization
• Maintain accurate provider profiles on Medicaid, PECOS, NPPES, and CMS databases
• Works collaboratively with leaders to resolve and respond to identify and resolve any denials or authorization issues related to provider credentialing
• Develop and maintain effective working relationships with and act as a liaison between government agencies and business representatives.
• Assist with special projects and other duties as assigned

Qualifications:

• Associate degree preferred
• Certified Provider Credentialing Specialist (CPCS) preferred
• 2 years of credentialing experience preferred

Knowledge, Skills, and Abilities:

• A high degree of attention to detail, strong organizational and critical thinking skills
• Strong written and verbal communication skills