Credentialing Specialist

General Description:

The Credentialing Specialist reports to the Vice President of Credentialing and will be responsible for completing provider credentialing and recredentialing applications, as well as assisting with provider enrollment with payers and compiling and maintaining current and accurate data for all providers.  In addition, in collaboration with leadership, the credentialing specialist will be responsible for developing the internal credentialing program, processes and procedures.

Responsibilities:

• Complete provider credentialing and recredentialing applications timely and monitor applications for follow up as needed.
• Maintain confidentiality and compliance with all regulatory and accrediting institutions.
• Maintain digital copies of current licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Set up and maintain online provider credentialing tracking system.
• Track license and certificate expiration for all providers to ensure timely renewals.
• Perform periodic audits on credentialing documentation.
• Single point of contact for credentialing for both hospitals and providers.
• Understand obligations as it relates to the Company’s Healthcare Compliance Program including participating in trainings, complying with policies and procedures, and alerting a supervisor to any potential violations.

Core Competencies:

• Proficiency in computer software, including but not limited to Microsoft Office Suite
• Keen attention to detail and time management skills; must be able to work independently and thrive in a remote team environment
• Excellent communication skills, attention to detail, customer service, and ability to interact with providers customers, management, and partners

Qualifications:

• High school diploma required, advanced degree and/or Certified Provider Credentialing Specialist (CPSS) preferred
• 2 – 3 years of experience performing similar duties and/or experience in a medical office setting