Credentialing Specialist

Job Description

Job Description

Description :

Credentialing Specialist

Eye Specialty Group is seeking a full-time Credentialing Specialist. The Credentialing Specialist is responsible for maintaining appropriate Credentialing, Privileges, and Plan Enrollment for Eye Specialty Group Physicians and Provident ASC Holdings, LLC.

This position will be expected to work in a hybrid capacity for location (both in the office at times and remote at times.)

Essential Skills / Responsibilities :

• Processes applications for new and renewed state medical licenses, keeping files updated and complete.
• Enrolls new providers in health plans and processes re-enrollments as needed.
• Credentials all providers with affiliated health plans.
• Obtains and processes applications for hospital privileges for all Medical Physicians.
• Notifies schedulers, clinic managers and doctors of physicians’ enrollments in health plans.
• Updates and assists ASC administrator with maintenance of ASC provider files.
• Tracks Provider CME credits earned and keeps informed of state CME requirements.
• Completes compliance training requested by company and required by law.
• Adheres to HIPAA compliance plan.
• Communicates internally with all ESG / PASCH / PPMS staff.
• Communicates externally with MetroCare, State Boards, etc.
• All other duties as assigned.

Requirements :

Job Specifications / Competencies :

Education / Training :

High school diploma or general education degree (GED); OR six months credentialing experience and / or training; OR equivalent combination of education and experience.

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.
• Demonstrated excellence in verbal communication, as well as, written communication.
• Good interpersonal and customer service skills.
• Critical thinking skills for identifying problems and resolutions in a fast-paced environment.
• Ability to calculate figures and amounts such as discounts, interest, commissions, percentages, area, circumference, and volume.
• Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical or complex instructions and deal with several abstract and concrete variables.
• Proficient in common business software; EMR preferred.
• Keyboard skills.

Attributes :

• Represents practice in a positive and professional manner.
• Punctual.
• Team player; willingness to help other staff.
• Attention to detail while multi-tasking.
• Diplomacy and confidentiality with patients and staff.
• Strong work ethic.
• Initiative / Self-Motivation.

Physical Requirements :

• Ability to sit / stand / walk as the job requires for long periods of time, as well as, climb / balance, lift, push / pull and stoop / crouch as needed.
• Ability to operate office equipment requiring the use of one hand.
• Ability to work in a moderate noise level clinic.

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