CREDENTIALING SPECIALIST

The Credentialing/Contracting Specialist will be responsible for all tasks associated with physician privileging and medical staff membership credentialing. The Specialist will communicate with outside agencies, including physician offices, hospitals, insurance carriers, and other healthcare agencies as required.

• Minimum Education: High School Diploma/G.E.D.

• Minimum 3+ years of experience with physician and facility credentialing is required.

• Experience with insurance carrier credentialing preferred

• Maintain strong skills in diplomacy, professionalism, and trustworthiness.

• Strong communication skills in both oral and written.

• Positive attitude, Team Player, and ability to work independently.

• Knowledge of EPower and Centricity is a benefit.

• Strong working knowledge of computers and Windows PC applications, such as Excel and Word, including the ability to learn new computer systems and applications.

• Ability to manage multiple priorities and projects.

• Detail-oriented with a desire to produce work with 100% accuracy.

• Excellent analytical and problem-solving skills.

JOB RESPONSIBILITIES/ DUTIES

• Responsible for internal credentialing of all providers in the practices and external consultants coming to the practices.

• Responsible for credentialing facilities with insurance carriers.

• Responsible for maintaining complete and up-to-date credentialing files for each provider and every practice to internal defined standards.

• Meets with providers to gather, review, and provide guidance on completion of credentialing packets.

• Coordinates the accurate input of physician information into CAQH, Medicare, Medicaid, and the internal tracking database.

• Responsible for the processing of accurate completion of Texas Standardized Credentialing Applications in MS Word files for each physician.

• Responsible for the input of physician documents into the database and the proper maintenance of all necessary documents mandated by the organization.

• Continuously verifies the status of CVs, provider licenses, DEA, DPS certificates, and specialty certificates; alerts leadership on any expirables not obtained and any provider who is not responding to open requests.

• Continuously tracks renewals of provider licenses, DEA, DPS, and ACLS certificates.

• Maintains record-keeping on providers’ CMEs and follows up with them to receive the CMEs they have completed.

• Ensures providers’ information is forwarded to the appropriate channels within the organization on a mandated basis.

• Completes various provider applications and tracks the status of applications once submitted to all insurance carriers.

• Maintains Contact information and provides it to leadership upon hiring of new providers and completion of the credentialing process.

• Updates the appropriate departments on the status of providers’ credentialing on Managed Care/Insurances.

• Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance.

• Perform other duties as assigned by the Director of Operations as necessary.

WORKING CONDITIONS

• The employee will be exposed to working conditions commensurate with a traditional office environment.
• The employee must be able to lift and/or move using proper body mechanics and agree to ask for assistance if required.
• While performing the duties of this job, the employee is frequently required to stand, walk, and sit.
• Must submit to random drug screenings.

Full-Time Benefit Perks:

• Health benefits start on the first of the month after hire
• Medical, dental, and vision plans with sliding-scale premiums
• 100% coverage for preventive health services
• HSA and FSA options available
• Company-paid life insurance and long-term disability
• 401(k) with contributions starting after 30 days
• 100% match on the first 4%,
• Full vesting after 3 years
• Access to exclusive employee discounts on travel, fitness, shopping, and more
• Paid Time Off
• Paid Holiday

Join us and make a significant impact on our company’s success in reaching our target audience and driving business growth.