Credentialing Specialist

Fresenius Medical Care•Austin, TX

About The Position

The Credentialing Specialist verifies credentialing documentation for all specialties that provide services to the organization's members. The role is responsible for submitting accurate and complete applications while meeting credentialing turnaround-time goals and following policies and processes that support state, regulatory, health and safety, and compliance requirements. The specialist verifies provider credentials and primary-source information, maintains provider files and credentialing database records, and completes payer enrollment and facility applications. The role also handles DUNS number activation and annual revalidations through SAMS, monitors credential expirations, performs quality checks, and supports assigned projects and other duties. Little to no travel is required.

Requirements

High school diploma.
2–4 years of related experience.
Excellent customer service and interpersonal skills.
Detail-oriented, with strong analytical and organizational skills.
Excellent oral and written communication skills.
Strong computer skills, including demonstrated proficiency with word processing, spreadsheet, database, and email applications.

Nice To Haves

Previous experience in health insurance.

Responsibilities

Verify and review specialty credentials, including Medicare, education, training, licenses, malpractice or professional liability insurance, CLIA licensure, and facility surveys, as applicable.
Enter provider information and primary-source verification data into the related database.
Create and maintain provider files in accordance with organizational policies.
Complete payer enrollment and facility applications accurately and on time, in line with department goals and metrics.
Contact relevant parties to obtain documents needed for credentialing applications, as directed.
Escalate missing items to leadership as directed to help avoid credentialing lapses.
Follow policies, procedures, and work instructions for the credentialing function.
Assist with goals and performance standards management.
Maintain data integrity in credentialing databases and core system records.
Improve efficiency and service while reducing costs.
Obtain DUNS numbers and complete the online SAMS application process to activate them.
Complete annual DUNS revalidations and other SAMS requests to maintain correct system information and help avoid payment and authorization delays.
Attend required training and use training materials, work instructions, and tools.
Develop knowledge of credentialing regulatory and accreditation requirements, including CMS and NCQA.
Monitor expirations monthly.
Perform quality checks.
Assist with projects assigned by the direct supervisor.
Perform other duties as assigned.