Credentialing Specialist

Requirements

• Gathers, researches, compiles and documents physician data used in the credentialing process.
• Investigates discrepancies, reports and documents findings.
• Maintains databases/records of required provider information, including but not limited to licensures and documents.
• Performs new provider credentialing activities including preparation of new provider files to be presented to the Board or Credentialing Committee per NCQA Standards.
• Ensures new Providers have hospital membership at all appropriate hospitals within the allotted time frame.
• Ensures new provider applications (Medicare/Medicaid/Tricare/TCMS/TMA, etc.) are submitted timely and follows through to completion.
• Performs the re-credentialing process to ensure all providers are re-credentialed within the re-credentialing renewal cycle.
• Assists in preparing reports of any discrepancies to the Board or Credentialing Committee.
• Ensures hospital privilege applications are sent to the appropriate facilities in a timely manner and addresses additional requests relating to such as necessary.
• Ensures credentialing files are kept current and orderly.
• Monitors/ tracks Medicare and Medicaid enrollment process. Addresses necessary issues regularly.
• Monitors licensure/insurance expiration date activity for both internal and external providers.
• Monitors all required regulatory websites as required by NCQA Standards. Documents findings. Reports any issues identified to Supervisor.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on CMSweb.
• Provides regular workload/productivity reports to supervisor.
• Responds professionally and effectively to questions from external sources, i.e., customer or carrier, and internal sources, i.e., provider or management team.
• Attends required in-services, training sessions, and department meetings.
• Performs other duties as assigned.

Benefits

• Medical
• Dental
• Vision
• Flexible Spending Accounts
• PTO
• 401(k)
• EAP
• Life Insurance
• Long Term Disability
• Tuition Reimbursement
• Child Care Assistance
• Health & Fitness
• Sick Child Care Assistance