Credentialing Specialist

Gastromed, LLC•Kendall, FL

10d

About The Position

The Credentialing Specialist is responsible for completing provider applications and reapplications, responding to requests for information from insurance companies, and tracking the status of physician applications with insurance companies and hospitals. This role also involves managing renewals for licenses, maintaining databases, obtaining hospital privileges, and ensuring accurate contract listings. The specialist will conduct primary source verification, validate provider information, and assist with identifying insurance plans for physicians. Additionally, they will maintain electronic resource files for practitioners and contribute to process improvement within the credentialing function.

Requirements

AA DEGREE REQUIRED.
MINIMUM TWO YEARS OF EXPERIENCE IN HEALTHCARE CREDENTIALING.
Knowledge of regulatory requirements and accreditation standards for provider credentialing.
Proficient in MS Office and intermediate in Excel, Word, and Outlook.
Experience in using credentialing software and databases.
Strong attention to detail and ability to maintain accurate records.
Excellent organizational and time management skills.
Effective communication skills, both written and verbal.

Responsibilities

Completes provider applications/reapplications.
Responds to requests from insurance companies for information/documentation.
Follow up with insurance companies and hospitals regarding the status of physician applications.
Notifies insurance carriers when a physician joins or leaves the practice.
Tracks the above information to promote the speed of processing.
Processes change of addresses for each practitioner/practice location.
Manages renewals (medical licenses, DEA's, occupational licenses) for all providers.
Maintains Availity, NPI, and CAQH databases and quarterly re-attestation.
Obtain Hospital Privileges for providers and re-credentialing.
Maintains a current and accurate contract listing, identifying the credentialing status of all physicians for the plan and updating the SharePoint site information.
Conduct primary source verification of credentials and qualifications.
Verify and validate provider information, including licensure, certifications, and education.
Assists Marketing in identifying all insurance plans by physicians. Updates the Insurance Plans via the FMC internet for each provider.
Maintains a resource file on each practitioner electronically, which includes copies of current licenses/CME/ DEA/malpractice/Board certifications/plan participation/ Hospital privilege information.
Assist in process improvement of the credentialing process.
Collaborate with internal teams to resolve credentialing issues or discrepancies.
Performs other related duties as required and assigned.