Credentialing Specialist

Credentialing Specialist

Premier Health Consultants Job Type Full-time Description

Responsible for all aspects of the credentialing and recredentialing processes for all medical providers that work in our clinics.

This includes maintenance of data for each provider. This position will also assist with provider onboarding and managed care contracting.

Essential Duties and Responsibilities include the following.

• Processing initial credentialing and re-credentialing applications.
• Screening practitioners' applications and supporting documentation to ascertain their eligibility.
• Collecting information from National Practitioner Data Bank (NPDB), applicant and their malpractice insurer, and other relevant sources.
• Identifying discrepancies in information and conducting follow-ups.
• Presenting applications to facility’s Credentialing Committee.
• Assisting with credentialing inquiries.
• Responding to health plan provider inquiries.
• Capturing primary source documentation in computer databases.
• Ensuring data is backed up.
• Ensuring compliance with applicable laws, regulations, procedures and policies. Credentialing Coordinator Requirement.
• Ensures completeness of provider credentialing and assists with managed care contracting projects as necessary.
• Updates provider licensure and documentation including but not limited to :

o Medical License

o CDS

o DEA

o CV

o Education / Residency / Board Certification

o CPR Certification

o All other required information

• Maintains high level of confidentiality.
• All other tasks as assigned

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies :

• Technical Skills - Strives to continuously build knowledge and skills; shares expertise with others.
• Customer Service - Responds promptly to customer needs.
• Interpersonal Skills - Maintains confidentiality.
• Oral Communication - Responds well to questions; participates in meetings.
• Written Communication - Presents numerical data effectively.
• Teamwork - Balances team and individual responsibilities; contributes to building a positive team spirit.
• Quality Management - Demonstrates accuracy and thoroughness.
• Business Acumen - Understands business implications of decisions; displays orientation to profitability.
• Cost Consciousness - Works within approved budget; develops and implements cost saving measures; contributes to profits and revenue;

conserves organizational resources.

• Diversity - Promotes a harassment-free environment.
• Ethics - Keeps commitments; works with integrity and ethically; upholds organizational values.
• Organizational Support - Follows policies and procedures.
• Judgment - Exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process;

makes timely decisions.

• Motivation - Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles.
• Planning / Organizing - Prioritizes and plans work activities; uses time efficiently; organizes or schedules other people and their tasks.
• Professionalism - Reacts well under pressure; accepts responsibility for own actions; follows through on commitments.
• Quality - Monitors own work to ensure quality.
• Adaptability - Changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.
• Dependability - Keeps commitments; commits to long hours of work when necessary to reach goals.

Requirements

Education and / or Experience High School Graduate / Specialized Training combined with 3+ years experience with office operations

Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.

Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Reasoning Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills To perform this job successfully, an individual should have knowledge of Microsoft Office and a minimum typing speed of 65 wpm

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand, sit, or walk; use hands to finger, handle, or feel;

reach with hands and arms and talk or hear; reach, stoop, bend, kneel, and / or crouch. The employee must frequently lift up to 50 pounds, occasionally lift up to 75 pounds, and sometimes lift up to 100 pounds.

Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually quiet to moderate. The employee may be exposed to infectious or contagious diseases and a variety of electromechanical hazards.