Credentialing Specialist
About The Position
The Credentialing Specialist coordinates credentialing, re-credentialing, and payer enrollment for providers in accordance with delegated credentialing agreements, organizational policies and procedures, industry best practices, and regulatory requirements. The role manages daily credentialing operations, including resolving cases involving non-responsive providers, and collaborates with clinic managers and the hospital medical staff office to ensure credentialing and re-credentialing are completed successfully and on time. The position performs credentialing and re-credentialing in line with departmental policies, accreditation standards, health plan requirements, and state and federal requirements. It also supports physicians and professional providers through hospital privileging, prepares materials for credentialing committee review, maintains correspondence and provider-status records, assists with productivity reporting, and helps prepare for health plan delegation oversight audits.
Requirements
- Two years of practitioner credentialing experience, or three years of administrative experience demonstrating the requisite job knowledge, skills, and abilities.
- Certified Provider Credentialing Specialist certification upon hire.
Nice To Haves
- Three years of administrative experience demonstrating the requisite job knowledge, skills, and abilities, preferably in a healthcare setting.
Responsibilities
- Coordinate credentialing, re-credentialing, and payer enrollment for providers.
- Manage daily credentialing operations, including resolving issues involving non-responsive providers.
- Collaborate with clinic managers and the hospital medical staff office to complete delegated credentialing and re-credentialing processes successfully and on time.
- Perform credentialing and re-credentialing according to departmental policies and procedures, accreditation standards, health plan requirements, and state and federal requirements.
- Provide assistance and guidance to physicians and professional providers through hospital privileging processes.
- Prepare files, letters, and summaries for Medical Staff Office and/or Franciscan Medical Group Credentialing Committee review.
- Maintain written and verbal correspondence and data collection records regarding provider status and the credentialing process.
- Assist with productivity reporting.
- Assist in preparation for health plan delegation oversight audits.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
