Credentialing Specialist

EyeSouth Partners•Atlanta, GA

16h

About The Position

Responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care, clinics, and facilities within the EyeSouth Partners Network. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

Requirements

Minimum of 2 years healthcare facility, provider, or payer credentialing experience in a multi-provider environment required
Must possess strong ethics and a high level of personal and professional integrity
Must possess strong analytical skills
Must be willing to seek out new methods and principles and be willing to incorporate them into existing practices, and willing to embrace new technology
Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint
Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level
Self-motivated with strong organizational skills and superior attention to detail
Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes
Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build consensus among cross-functional teams
Strong problem solving and negotiation skills

Responsibilities

Compiles and maintains current and accurate data for all providers.
Manages provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers, clinics, and facilities.
Maintains corporate provider contract files.
Maintains knowledge of current health plan and agency requirements for credentialing providers.
Enters and maintains provider information in online credentialing databases and systems.
Manages clinical and facility license and certification expirations to ensure timely renewals and regulatory compliance.
Ensures practice addresses are current with health plans, agencies, and other entities.
Processes applications for appointment and reappointment of privileges.
Monitors license, DEA, and professional liability expirations for appointed providers.
Maintains ASC appointment files and information in credentialing database.
Audits health plan directories for current and accurate provider information.
Enhances and standardizes work – flow processes throughout the revenue cycle process to assist in achieving consistency in maintaining the critical success factors outlined in the firms standard operating procedures.
Monitors timeliness and effectiveness of department activities, ensuring that outstanding account receivables are consistent with contracted standards.
Communicates/facilitates special projects and requests.
Compiles and prepares various status reports to analyze trends and make recommendations.
Contributes to the team effort by completing other tasks/projects as needed.