Credentialing Specialist

JOB PURPOSE: Responsible for all aspects of provider credentialing and re-credentialing with insurance companies, the hospitals, clinics and any other patient care facilities.

ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:

• Will maintain a data base of all participating insurance plans/provider
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Set up and maintains provider information online credentialing databases and
• Completes, submits and confirms electronic funds transfers that is required in association with enrollment forms, as
• Manages workload to meet deadlines and maintain department standards on turnaround time to insure timely payor effective
• Contacts providers/clients, provider medical office staff, licensing agencies, payor provider representatives and insurance carriers to complete contracting
• Communicates with providers to obtain requisite credentialing information to facilitate timely completion and submission of required
• Facilitate physician applications, notify all necessary personnel and review applications for competency and
• Track and monitor processing and completion of applications at all hospitals
• Monitor providers health files and assist the Employee Health nurses at the facilities in receiving the paperwork
• Notify providers, copying administration, of licenses and certifications expiring in advance and send weekly reminders until license/certificates are
• Acts as a liaison and credentialing resource for medical staff members and medical staff office personnel.
• Maintain credentialing
• Other duties as assigned

BEHAVIORAL STANDARDS

• The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.
• Exhibit positive customer service behavior in everyday work interactions.
• Demonstrate a courteous and respectful attitude to internal workforce and external customers.
• Communicate accurately and appropriately.
• Handle difficult situations in a discreet and professional manner.
• Hold self-accountable for professional practice.
• Participate in performance improvement activities utilizing principles to support and improve departmental goals.
• Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.
• Keep current with literature regarding changing practices, interventions and best practices.
• Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.
• Act as a preceptor as requested.
• Demonstrate excellent work attendance and actively participate in a variety of meetings and training sessions as required.
• Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.

QUALIFICATIONS:

• Experience in physician credentialing required
• Two years of relevant experience in hospital and/or healthcare credentialing.
• Demonstrates oral and written communication skills to obtain and convey information clearly, accurately and in a timely manner. Ability to compose and create logical and grammatically correct correspondence.
• Ability to work efficiently with minimum supervision and set priorities to meet varying demands, changes in priorities and competing
• Excellent interpersonal skills to effectively interact with all levels of staff and facility
• Excellent organizational skills
• Ability to maintain confidentiality in handling sensitive documents and
• Skills in operating PC hardware
• Knowledge of Adobe and Microsoft Outlook, Excel, and Word
• Able to communicate effectively in English, both verbally and in writing.

EDUCATION/CERTIFICATION/LICENSURE:

• High School Diploma or GED required; Associates degree or Bachelor’s degree in a healthcare related field preferred.
• Medical staff services certification preferred:
• Certified Professional Medical Services Management (CPMSM) or
• Certified Provider Credentialing Specialist (CPCS) or
• Education plan to obtain in 12 months

PHYSICAL REQUIREMENTS:

• To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.
• This job requires visual abilities, auditory abilities, must be intact to perform duties.

Work Remotely:

• No

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• hospital or healthcare credentialing: 2 years (Preferred)

License/Certification:

• Certified Professional Medical Services Manager (Preferred)
• Certified Provider Credentialing Specialist (Preferred)

Work Location: One location