What are the responsibilities and job description for the Credentialing Specialist-Full Time-Days position at Cape Fear Valley Medical Center?
Facility
Cape Fear Valley Medical Center
Location
Fayetteville, North Carolina
Department
Physician Financial Services
Job Family
Clerical
Work Shift
Days (United States of America)
Summary
Develop and maintain an effectively functional fully integrated credentialing process by working with physicians, third party payors and managed care companies to obtain provider numbers in a timely manner.
Major Job Functions
The following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below. In addition, specific functions may change from time to time:
- Develops and maintains credentialing files on physicians with current updated information for use in credentialing process
- Works directly with physicians to verify the accuracy of the credentialing information
- Provides updated information and progress on timely basis to Physician Billing Department, Physician and Business Development Department
- Coordinates the credentialing process with the electronic billing third party payors
- Meets with new physicians prior to start date to discuss credentialing and obtains signatures necessary to complete manage care applications
- Works closely with provider representatives at managed care companies to provide additional information needed to complete credentialing process
- Complete and process re-credentialing applications for physicians according to guidelines.
- Completes out-of-state applications for plan enrollments of physicians and clinics
- Other duties as assigned
Minimum Qualifications
The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:
Education and Formal Training:
- High school diploma or equivalent required
Work Experience:
- 3 years experience in working in the medical field which include a working knowledge of medical staff, third party payors, and organization preferred
Knowledge, Skills, and Abilities Required:
- Knowledge of computer functions
- Knowledge of medical terminology, CPT-4 and ICD-9 coding
- Numerical ability required
- Organizational skills
- Excellent oral and written communication to communicate effectively with co-workers, supervisors and members of the medical staff
- Thorough on procedures and coordinating details
- Preference for contacts with people involving considerate tact and diplomacy
Physical Requirements:
- Motor coordination and finger dexterity required to operate the calculator and computer terminal
- Reaching for and handling files
- Talking and hearing to give and receive information by phone
Required Licenses and Certifications
Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity