Credentialing Specialist

Omaha Tribe of NebraskaMacy, NE, USA

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SUMMARY : The Credentialing Specialist is responsible for preparing, submitting and maintain enrollment, credentialing and recredentialing documentation for physicians and other health care providers.

ESSENTIAL DUTIES and / or RESPONSIBILITIES include the following :

Responsible for Compiling and maintaining current and accurate data for all providers
Responsible for Data entry and maintaining provider information in online credentialing databases and systems.
Responsible for PrimeSource Verification of State licensure, DEA, and Board Certification
Responsible for Completing provider initial and re-credentialing applications
Audio applications for accuracy and completeness
Responsible for revalidation requests issued by Government payers
Responsible for Submitting completed credentialing applications and supporting documentation to all requested payers.
Responsible for monitoring application progress and following up with payers as needed until confirmation of "in network" status has been received
Responsible for maintaining copies of current state licenses, DEA Certifications, malpractice coverage and any other required documents for all providers. As well as tracking all state license, DEA, and board certifications expirations for all providers to ensure timely renewals
Responsible for tracking CME and sending quarterly updates to providers
Utilizes strong research skills to gather pertinent information regarding providers
And all other duties assigned

KNOWLEDGE, SKILLS AND ABILITIES

Familiar with provider credentialing and recredentialing requirements

Strong analytic computer and software skills

Excellent interpersonal skills including excellent verbal and written communication skills

Ability to demonstrate a high degree of trust and confidentiality

Ability to work independently and assume assigned responsibility

Skilled efficiency, organization, time management and prioritization

Ability to be flexible and function will in a fast-paced environment

Ability to deal with problems involving several concrete variables in standardized situations

Ability to communicate effectively and relate to people of different cultures

Ability to handle confidential information

QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each 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 duties.

EDUCATION AND / OR EXPERIENCE :

High School Diploma and minimum of (2) years related experience preferred; or at least four years related experience and training; or an equivalent combination and work experience considered.

Working Knowledge of credentialing accreditation regulations, policies and procedures

Certified Professional Credentialing (CPCS) Certification preferred

Payer Provider Enrollment : (1) year (preferred)

Healthcare : 1 year (preferred)

COMPUTER SKILLS :

Expert level Knowledge of Microsoft Office Products.

Experience with credentialing software preferred.

PLEASE NOTE : P.L. 93-638, Indian Preference and Tribal Employment rights Ordinance. (T.E.R.O) will be practiced; however, all qualified applicants will be considered.

Please note that the job description is subject to change with or without prior notice.

IF YOU ARE INTERESTED, PLEASE SEND APPLICATIONS RESUME TO :

OMAHA TRIBE OF NEBRASKA

ATTN : HR DEPARTMENT

P.O. BOX 368

MACY, NEBRASKA 68039

EMAIL :

Must pass background check, physical, and pre-employment drug screen.

Job Posted by ApplicantPro

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Credentialing Specialist • Macy, NE, USA