Credentialing Specialist

Avera•Sioux Falls, SD

13h•Onsite

About The Position

Accountable for ensuring the credentialing requirements for governmental agencies and commercial managed care insurers/networks are met and managed appropriately so medical providers are enrolled in and maintain active credentialing status with such entities.

Requirements

The individual must be able to work the hours specified.
Visual acuity adequate to perform position duties.
Ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
Associate's or an equivalent combination of education and experience
1-3 years medical experience and/or training; or an equivalent combination of education and experience

Nice To Haves

Knowledge of PECOS Medicare organizational enrollment.

Responsibilities

Responsible for the coordination of the credentialing process for the medical providers including obtaining all relevant documentation and application forms.
Knowledge of all applicable state and federal laws and accrediation standards regarding credentialing and applies them to the credentialing process, which includes knowledge of PECOS Medicare organizational enrollment.
Responds to applicants and current medical providers regarding the credentialing process and status.
Responsible for accurate data entry and maintenance of the credentialing system.
Assures files are complete and accurate for all clinics, providers, hospitals and also includes outreach hospitals.
Assures that all re-credentialing paperwork is complete and accurate and ready for approval within the timeframes required by the payors.
Assures that providers are notified between reappointment cycles by keeping accurate records of expiration dates.
Maintaining NPI website and furnishing current W-9’s as requested.