What are the responsibilities and job description for the Credentialing Specialist position at The Evolve Center of Counseling LLC?
Key Responsibilities:
- Verification and Documentation:
- Collect, review, and verify the credentials of healthcare professionals, including licenses, certifications, and educational transcripts.
- Ensure the accuracy and completeness of provider applications and supporting documents.
- Maintain comprehensive and accurate records of provider credentials, ensuring compliance with regulatory and organizational standards.
- Conduct primary source verification to confirm the accuracy of information provided by healthcare professionals.
- Compliance and Regulations:
- Stay up-to-date on current credentialing regulations, policies, and standards.
- Ensure compliance with federal, state, and local regulations related to healthcare provider credentialing.
- Maintain confidentiality of provider information, adhering to HIPAA guidelines.
- Database Management:
- Enter, update, and maintain data from provider applications into credentialing databases.
- Monitor and track credential expiration dates and ensure timely renewals.
- Manage and maintain provider profiles in various health insurance portals and databases.
- Communication and Collaboration:
- Communicate with healthcare providers, insurance companies, and other stakeholders regarding credentialing matters.
- Answer questions from providers, customers, and staff regarding the credentialing process.
- Collaborate with other departments, such as human resources and medical staff services, to ensure smooth credentialing processes.
- Other Duties:
- Assist with the recredentialing process, ensuring that healthcare professionals meet ongoing requirements.
- May be involved in developing and implementing credentialing policies and procedures.
- May assist with the onboarding of new healthcare providers.
- May be responsible for tracking CME (Continuing Medical Education) requirements.