Credentialing Specialist

Job Title : Credentialing Specialist

Job Status : Full-time

Job Summary : Under general supervision the Credentialing Specialist will play a critical role in supporting the Community Health & Research Center fee for service environment the billing division and contributing to patient safety and satisfaction. This role is responsible for ensuring that healthcare professionals and facilities maintain appropriate credentials and meet all regulatory and organizational standards in ensuring that physicians and other healthcare providers meet all necessary qualifications and standards. This role manages the credentialing process to support the delivery of quality healthcare services and maintaining the integrity and quality of healthcare expertise.

Essential Duties and Responsibilities :

Verify the credentials licensure certifications and qualifications of medical and healthcare professionals and ensure compliance with relevant regulations and industry standards

Conduct thorough checks of educational background training licensure certification and work experience of healthcare providers and ensure the accuracy of completeness

Maintain records of all credentialing activities including updated information on licenses certifications and malpractice insurance

Ensure that all healthcare providers comply with state and federal regulations as well as industry standards and organizational policies

Oversee the re-credentialing process for all health care providers and ensure timely renewal of credentials and certifications avoiding any lapse in compliance

Verify the accuracy of health care provider information including education training experience and licensure

Maintain and update credential files and databases warranting compliance with current regulations and standards

Communicate with healthcare providers regulatory agencies and other stakeholders to resolve credentialing issues

Coordination between healthcare providers insurance companies and regulatory agencies facilitating timely and accurate exchange of information

Prepare and present credential reports to management and relevant committees

Assist in preparing for internal and external audits providing necessary documentation and information to auditors

Stay informed about changes in healthcare regulations and credentialing requirements

Operate standard office equipment and use required software applications

Perform other duties and responsibilities as assigned

Knowledge Skills and Abilities :

Knowledge of :

Credentialing regulations policies and procedures

Relevant state and federal regulations as well as standards set by accrediting bodies such as The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA)

Healthcare regulations and compliance standards

Proficiency in credentialing software and databases as well as standard office applications

Skill in :

Strong attention to detail and organizational skills

Excellent written and verbal communications and interpersonal skills

Excellent organizational skills to manage multiple tasks and deadlines effectively

Operating standard office equipment and using required software applications for program area and other applications including Microsoft Office

Ability to :

Manage multiple deadlines

Mutti task and able to negotiate and coordinate between multiple entitles in order to solve a issues

Be patient self-control and provide a solution to issues

Build positive relationships with healthcare providers

Demonstrate a high degree of trust and confidentiality

Work independently

Educational / Previous Experience Requirements :

Minimum Degree Required :

o Bachelors degree

Required Disciplines :

o Healthcare Administration Business Administration or a related field

3 to 5 years experience or any equivalent combination of experience education and / or training approved by Human Resources

Licenses / Certifications :

Licenses / Certifications Required at Date of Hire :

o (CPCS) Certified Provider Credentialing Specialist is strongly preferred

Working Conditions :

Hours : Normal business hours some additional hours may be required

Travel Required : None generally required; Local in-state national and international travel up to 10%

Working Environment : Climate controlled office

Required Experience :

Unclear Seniority

Key Skills

Sales Experience,Crane,Customer Service,Communication skills,Heavy Equipment Operation,Microsoft Word,Case Management,OSHA,Team Management,Catheterization,Microsoft Outlook Calendar,EHS

Employment Type : Full Time

Experience : years

Vacancy : 1