Credentialing Specialist

Open Health Care Clinic•Baton Rouge, LA

23d

About The Position

Responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care. 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

High school diploma or equivalent required.
File Management and Organization
Excellent Verbal and Written Communication
Proficient Typing
Data Entry
Attention to Detail
Confidentiality
Thoroughness
Experience with Microsoft Word and Excel.

Nice To Haves

Associate or Bachelor degree preferred.
Certified Provider Credentialing Specialist (CPCS) preferred.

Responsibilities

Compiles and maintains current and accurate data for all providers.
Completes 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.
Maintains provider contract files.
Maintains knowledge of current health plan and agency requirements for credentialing providers.
Sets up and maintains provider information in online credentialing databases and system.
Tracks license and certification expirations for all providers to ensure timely renewals.
Ensures practice addresses are current with health plans, agencies and other entities.
Processes applications for appointment and reappointment of privileges
Tracks license, DEA and professional liability expirations for appointed providers.
Maintains appointment files, and information in credentialing database.
Audits health plan directories for current and accurate provider information.