What are the responsibilities and job description for the Credentialing Specialist position at Private Practice?
JOB TITLE: Credentialing Specialist
REPORTS TO: Revenue Cycle Manager
FLSA STATUS: Non-Exempt
QUALIFICATIONS/EDUCATION:
- AA Degree required.
- Minimum two years of experience in healthcare credentialing.
- Knowledge of regulatory requirements and accreditation standards for provider credentialing.
- Proficient in MS Office and intermediate in Excel, Word, and Outlook.
- Experience in using credentialing software and databases.
- Strong attention to detail and ability to maintain accurate records.
- Excellent organizational and time management skills.
- Effective communication skills, both written and verbal.
SUPERVISORY RESPONSIBILITIES:
N/A
ESSENTIAL DUTIES/ RESPONSIBILITIES:
- Completes provider applications/reapplications.
- Responds to requests from insurance companies for information/documentation.
- Follow up with insurance companies and hospitals regarding the status of physician applications.
- Notifies insurance carriers when a physician joins or leaves the practice.
- Tracks the above information to promote the speed of processing.
- Processes change of addresses for each practitioner/practice location.
- Manages renewals (medical licenses, DEA's, occupational licenses) for all providers.
- Maintains Availity, NPI, and CAQH databases and quarterly re-attestation.
- Obtain Hospital Privileges for providers and re-credentialing.
- Maintains a current and accurate contract listing, identifying the credentialing status of all physicians for the plan and updating the SharePoint site information.
- Responds to requests from insurance companies for information/documentation.
- Conduct primary source verification of credentials and qualifications.
- Verify and validate provider information, including licensure, certifications, and education.
- Assists Marketing in identifying all insurance plans by physicians. Updates the Insurance Plans via the FMC internet for each provider.
- Maintains a resource file on each practitioner electronically, which includes copies of current licenses/CME/ DEA/malpractice/Board certifications/plan participation/ Hospital privilege information.
- Follow up with insurance companies and hospitals regarding the status of physician applications.
- Assist in process improvement of the credentialing process.
- collaborate with internal teams to resolve credentialing issues or discrepancies.
- Performs other related duties as required and assigned.
Qualified individuals, please submit your resume.
We offer a competitive salary; Employee Health Insurance is covered at 100%. We also offer Dental, Vision, Life, and 401k Benefits.