Specialist, Credentialing

Overview

The Credentialing Specialist is responsible for initiating, tracking and updating all credentialing. This individual should possess a high degree of professionalism, strong interpersonal skills, attention to detail and maintain strict confidentiality.

Responsibilities

Essential Job Duties and Responsibilities

• Knowledge of federal and state regulatory requirements and accreditation standards (., Joint Commission, CMS)
• Maintain, track, and update all credentialing documents, including checking all applications for accuracy and completeness and providing status to need-to-know parties in timely manner.
• Completes initial and re-credentialing applications on all physicians
• Update and maintain all licensures, CVs, DEAs, and certificates
• Tracks expiable information for all providers to ensure timely renewals.
• Maintains excellent working relationships with the facilities to ensure timely and accurate credentialing status
• Maintains strict confidentiality regarding protected health information understands HIPAA Privacy & Security policies and procedures
• Maintains strict confidentiality regarding provider information.
• Performs other duties and special projects as assigned by Supervisor or Director

Qualifications

Education and / or Experience

• High School Diploma or GED
• Minimum of two years’ experience in credentialing
• Excel, Word, Adobe experience

Skills / Specialized Knowledge

• Knowledge of Joint Commission Standards
• Proficient and accurate in data entry.
• Ability to prioritize workload and meet strict deadlines.
• Strong problem-solving skills and attention to detail.
• Ability to prepare and write reports, summaries of work / work projects.
• Strong personal motivation with ability to work with little supervision and attention to detail while working in a deadline driven environment.
• Ability to think creatively, highly driven, self-motivated, highly organized.
• Ability to courteously work with medical staff, hospital staff, insurance company representatives, co- workers, and others
• Familiar with Texas Standardized Credentialing Application
• Familiar with the verification process
• Familiar with the ability to apply a physician to a Licensing Authority

Other Requirements

• Must maintain professional appearance.
• Ability to be at work on a regular and consistent basis

Physical and Mental Demands

This position will spend long hours sitting and using office equipment and computers. The position may also entail light lifting of supplies and materials occasionally, up to and including 20 pounds in addition to reaching, stooping, standing, and walking.

This position requires the ability to talk, hear, compare, compute, compile, copy, analyze, coordinate, synthesize, negotiate and communicate.

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

Work Environment

Standard office working environment that may be busy and noisy at times.

IND123