Credentialing Specialist

Appalachian Regional Healthcare•Lexington, KY

10h

About The Position

The Credentialing Specialist is accountable for performing the credentialing, re-credentialing and privileging process for the organization. The Credentialing Specialist reports directly to the System Director of Medical Affairs and Provider Enrollment.

Requirements

High School diploma required
Entry Level
Knowledge and understanding of the credentialing process
Ability to organize and prioritize work and manage multiple priorities
Excellent verbal and written communication skills including letters, memos and emails
Excellent attention to detail
Ability to research and analyze data
Ability to work independently with minimal supervision
Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization
Proficient use of Microsoft Office applications (Word, Excel) and internet resources

Nice To Haves

Associate degree preferred
Certification as a Certified Provider Credentialing Specialist (CPCS) preferred, but not required.
two (2) years of relevant credentialing experience preferred.

Responsibilities

Responsible for processing and maintaining credentials files.
Responsible for timely and accurate completion of routine and assigned credentialing tasks (see major activities listed)
Process pre-applications
Prepare application packets and send to provider for completion
Reviews and screens initial and reappointment credentialing applications for completeness, accuracy and compliance with organization guidelines, regulations, policies and standards
Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential practitioners
Discovers and conveys problems to Medical Affairs for sound decision making in accordance with Medical Staff Bylaws and credentialing policies and procedures
Participates in the development and implementation of process improvements for the system-wide credentialing process
Communicates clearly with providers, their liaisons, Medical Affairs, Medical Staff leadership and administration as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise
Sets up and maintains provider information in online credentialing databases and system
Maintains professional growth and development through seminars, workshops and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry
Perform primary source verification for all required elements of the credentialing file
Coordinate with the Medical Staff Office to submit completed files for recommendation/approval through the Medical Staff process
Maintains confidentiality of provider information
Performs miscellaneous job-related duties as assigned