SUMMARY:
The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by SBCHC, commercial payers, Medicare and Medicaid.
QUALIFICATIONS:
- High school graduate or equivalent
- 2 years credentialing experience preferred
- Knowledge of provider credentialing and its direct impact on the practice's revenue cycle
- Excellent computer skills including Excel, Word, and Internet use
- Detail oriented with above average organizational skills
- Plans and prioritizes to meet deadlines
- Good oral and written communication skills
- Ability to deal professionally, courteously and efficiently with the public and all levels of the organization
- Ability to handle multiple projects simultaneously
- Ability to operate computer, copier, fax
- Proficient in practice management system and Microsoft Office software applications
- Knowledge of HIPAA guidelines and requirements
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Maintain individual provider files to include current information needed to complete the required SBCHC and insurance credentialing applications.
- Maintain internal provider list to ensure all information is accurate and logins are available.
- Update and maintain accurate profiles for each provider's CAQH, PECOS, NPPES, CMS
- Complete revalidation requests in a timely manner.
- Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid and new facilities.
- Complete re-credentialing applications for all payers.
- Work closely with the billing manager and billing staff to identify and resolve any denials issues related to provider credentialing.
- Work special projects assigned by billing manager.
- Other duties as assigned
- Cross trained to provide billing department coverage in any task needed to meet end of the month deadlines.
- Responsible for staying current with the rules and updates or changes in state and federal regulations.
- Continually search for ways to improve the accounts receivable process, striving for efficiency in daily operations.
- All Health Center staff members have emergency and disaster response responsibilities. Participates in all safety programs which may include assignment to an emergency response team.