Job Description
Our client in the healthcare space is looking for a Credentialing Specialist to join their team.
What You'll Be Doing: - Conducts comprehensive background investigations, research, and evaluation of components in application files; completes credentialing and re-credentialing for providers; monitors applications and follows up as needed; processes applications with relevant agencies or third-party payers to ensure compliance.
- Manages credentialing for faculty and professional staff with Medicare, Medicaid, HMOs, PPOs, and other third-party carriers to secure provider contracts.
- Maintains accurate and up-to-date provider data in databases and online systems, including information on education, training, licensing, and experience, ensuring practice addresses remain current with health plans, agencies, and other entities.
- Applies for providers’ hospital privileges and oversees hospital reappointments, as well as managing requests and payments for medical staff dues to ensure timely and accurate handling.
- Assists in maintaining the Clinical Laboratory Improvement Amendments (CLIA) certification for clinical operations.
- Tracks the expiration dates of provider licenses and certifications to ensure timely renewals.
- Ensures contact and licensing information does not lapse, submitting updated licensing information to the appropriate entities.
- Maintains secure credential files for providers and supports college review committees.
- Stays informed about new policies and procedures from third-party payers and communicates relevant updates to appropriate staff.
- Ensures compliance with accrediting and regulatory agencies, and maintains a working knowledge of statutes and laws related to credentialing.
- Assists with managed care delegated credentialing audits, conducts internal file audits, and verifies health plan directories for accurate provider information.
- Responds to inquiries from other healthcare organizations and interfaces with internal and external stakeholders on credentialing and privileging issues.
- Participates in contracting functions, maintaining an understanding of contract terms.
- Performs other duties as assigned by the supervisor.
Experience You Bring: - Thorough knowledge of the credentialing process.
- Familiarity with accreditation and certification requirements related to credentialing.
- Strong ability to work independently while efficiently managing multiple projects with precision, adapting to change, and meeting deadlines.
- Skilled in researching and analyzing data.
- Dedicated to delivering excellent customer service, fostering effective working relationships with providers, staff, and both internal and external contacts.
- Exceptional attention to detail and a high level of accuracy.
- Effective verbal and written communication skills.
- Proficiency in MS Office applications (Word, Excel, and Outlook) and strong skills in online research.
- Experience in credentialing and/or insurance contracting within a medical setting.
- Experience using credentialing software.
- Certified Provider Credentialing Specialist (CPCS) qualification.
Job Tags
Contract work, Temporary work,