Credentialing Specialist

Highlands Oncology began in 1996 with three physicians and a desire to change the face of oncology care in our community.  Dr. Malcolm Hayward, Dr. Dan Bradford, and Dr. Thad Beck knew that patients do better at home, in the community where they live and work, and where their support system is already in place. In furthering that goal, Highlands has grown with the region from a single location 26 years ago, to 6 locations in Northwest and Northcentral Arkansas today employing more than 800 diverse team members.

As Northwest Arkansas continues to grow, so must the services and providers available in the region.  Highlands Oncology is committed to remaining on the cutting edge to ensure our community has access to the very best cancer care.  What we have is something quite unique right here in our own backyard with a caring multidisciplinary team focused on treating patients like family.

Job Summary: The Credentialing Specialist, under the general direction of the Credentialing Coordinator, provides administrative, operational, and provider-facing support for Highlands Oncology Group, P.A.'s credentialing, recredentialing, privileging, enrollment, and related provider compliance processes. This position supports the Credentialing Coordinator and Credentialing and Enrollment Analyst(s) by collecting and maintaining required information and documentation, preparing and tracking applications and submissions, monitoring deadlines and outstanding requirements, performing routine verifications, maintaining credentialing systems and records, and following up with providers and other stakeholders.

The Credentialing Specialist performs assigned duties in accordance with established procedures and department direction and promptly escalates deficiencies, conflicting requirements, unusual circumstances, adverse determinations, or matters requiring interpretation or independent judgment to the Credentialing Coordinator or Credentialing and Enrollment Analyst.

Job Duties / Responsibilities:

• Provides administrative, operational, and provider-facing support to the Credentialing Coordinator and Credentialing and Enrollment Analyst(s) in credentialing, recredentialing, privileging, enrollment, and related provider compliance activities.
• Compiles, maintains, updates, and tracks accurate credentialing and demographic information for Highlands providers and facilities in accordance with established procedures.
• Assists with the preparation, completion, submission, and tracking of provider credentialing, recredentialing, privileging, enrollment, revalidation, and related applications and supporting documentation as assigned.
• Tracks application status, deadlines, expirations, outstanding documentation, signatures, attestations, and other requirements and performs timely follow-up to help ensure required submissions are completed by applicable deadlines.
• Proactively communicates with providers regarding outstanding credentialing, privileging, renewal, verification, and documentation requirements through approved communication methods, including in-person communication, telephone, electronic messaging, and text messaging.
• Provides hands-on assistance to providers completing credentialing and privileging paperwork, applications, attestations, renewals, and other required submissions.
• Travels to Highlands locations and other approved locations as needed to meet with providers and assist them with completing required credentialing and privileging activities.
• Assists providers with accessing and navigating credentialing, privileging, licensing, and other required systems and resources and coordinates additional technical or departmental assistance when necessary.
• Maintains current copies of provider licenses, certifications, accreditations, DEA registrations, malpractice coverage, and other required credentialing or regulatory documentation.
• Tracks provider and applicable clinical staff license, registration, certification, and other credential expirations and initiates reminders and follow-up sufficiently in advance of applicable deadlines.
• Assists with applications, supporting documentation, and follow-up related to hospital appointment, reappointment, membership, and clinical privileges.
• Assists with malpractice liability insurance applications, renewals, documentation, and routine communications with insurance carriers as assigned.
• Populates and maintains provider and facility information in internal and external credentialing databases, portals, tracking systems, and records with a high degree of accuracy.
• Performs routine credentialing and privileging verifications, including primary-source verification, as assigned and in accordance with established procedures.
• Supports credentialing activities associated with new provider onboarding by collecting required information, coordinating documentation, assisting providers with required systems, and tracking completion of assigned requirements.
• Maintains credentialing, privileging, provider, facility, and related department records and files in accordance with established recordkeeping and confidentiality requirements.
• Coordinates routine communications among providers, credentialing staff, facilities, payors, licensing agencies, and other stakeholders and routes questions or matters requiring substantive interpretation to the appropriate Credentialing and Enrollment Analyst or Credentialing Coordinator.
• Monitors assigned credentialing activities for approaching deadlines, missing information, stalled processes, or other potential issues and promptly escalates concerns to the Credentialing Coordinator or Credentialing and Enrollment Analyst.
• Follows established department workflows, standards, procedures, and controls and identifies opportunities or recurring issues that may improve the provider credentialing experience, efficiency, accuracy, or timeliness.
• Maintains strict confidentiality and appropriately safeguards provider, organizational, and other sensitive information.
• Provides responsive, professional, and service-oriented assistance to providers and other internal and external stakeholders.
• Performs other duties as assigned consistently with the needs of the organization.