Credentialing Specialist

JOB SUMMARY:

This position is responsible for establishing, monitoring, and maintaining provider credentialing with employer groups, managed care organizations, insurance companies, medical staff office and physicians.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Upholds and supports the mission, philosophy, objectives, policies and ethics of CHSI.
• Protects organization's value by keeping information confidential.
• Carries out and completes the credentialing process for new and existing Providers.
• Monitors, updates and advises supervisors of Provider and clinic licenses to ensure they are kept current.
• Conducts pre-employment data query on Provider applicants.
• Understands and carries out the necessary process to ensure laws and regulations concerning Provider credentialing and clinic licensing are met.
• Queries electronically the National Practitioner Data Bank for initial appointment, reappointments, change in privileges, and temporary privileges for each clinic.
• Processes all initial applications for Medical/Allied Health Professional Staff appointments and clinical privileges to meet clinic operation policies and procedures.
• Maintains up-to-date license and certified Provider database, including medical licenses, drug enforcement administration (DEA) certificates, malpractice insurance, and renewal period expiration dates.
• Communicate with Medical/Dental Directors continually and provides monthly about expiration reports and provide rosters when requested.
• Maintains organized credential files and assists with inspections by regulatory authorities or accreditation surveyors, and ensures that all information meets federal and state guidelines when processing applications.
• Ensures all requests for privileges are processed in a timely manner.
• Ensures credentialing files are kept current and are in compliance.
• Responds to provider inquiries received by letter, phone, email or internal departments.
• Perform all other duties as directed either formally or informally, verbally or in writing.

SUPERVISORY RESPONSIBILITIES:

This job has no supervisory responsibilities.

KNOWLEDGE, SKILLS AND ABILITIES:

• Strong organizational skills and attention to detail; ability to manage multiple responsibilities simultaneously.
• Strong computer skills, with proficiency in Microsoft Office, database software and internet applications
• Well-developed verbal and written communication skills and the ability to work cooperatively with divergent groups
• Keeps abreast of changes in laws and regulatory requirements.
• Must possess good "customer service" including verbal and written communication.
• A high standard of professionalism and professional ethics and conduct is expected in speech, manner, attitude and appearance at all times.
• Possess strong interpersonal skills and ability to work well with others.
• Ability to deal effectively with changing situations and stressful environment.
• Ability to perform tasks related to physical activity to complete the responsibilities of the position.

EXPERIENCE AND EDUCATION:

• Minimum high school graduate or GED
• Associate's degree or equivalent from two-year college or technical school; OR
• Six months to one (1) year related experience and/or training; OR
• Equivalent combination of education and experience