Credentialing Specialist

HUTCHINSON CLINIC P A INC•Hutchinson, KS

About The Position

Ensure that Clinic Providers are credentialed and appointed with health plans and the Clinic, ASC and other facilities as applicable. Process applications and verify licensing and certifications in a timely manner.

Requirements

Experience: One year of previous healthcare credentialing experience or a minimum of 5 years of healthcare related insurance billing, compliance and/or A/R or any combination of these with knowledge and understanding of credentialing and re-credentialing processes.
Education: High School Education or equivalent required. Associates degree in business or completion of a specialized course of study at a business or trade school or completion of a specialized and extensive in-house training or apprenticeship program.
Other Skills: Intermediate knowledge of Microsoft Word, Outlook, and Excel applications. Ability to work independently with minimal supervision. Ability to organize and prioritize work and manage multiple priorities. Strong analytical and problem-solving skills. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. Effective verbal and written communication skills. Ability to maintain good judgement when handling sensitive and personal information.

Responsibilities

Compile and maintain current and accurate data for all providers.
Complete provider credentialing and recredentialing applications; monitor applications and follow-up as needed.
Maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
Maintain knowledge of current health plan and agency requirements for credentialing providers.
Set up and maintain provider information in online credentialing databases and system.
Track license and certification expirations for all providers to ensure timely renewals.
Ensure clinic addresses are current with health plans, agencies and other entities.
Process applications for appointment and reappointment of privileges to other healthcare facilities as applicable.
Track license, DEA, and professional liability expirations for providers.
Maintain appointment files, and information in credentialing database.
Audit health plan directories for current and accurate provider information.
Provides credentialing and privileging verifications.
Consistently demonstrate good use of time and resources
Attend training events and maintain competency as required to perform duties.
Regularly support compliance and accreditation efforts as assigned (e.g., OSHA, HIPAA)
Be familiar with and consistently implement the organizations mission and all approved policies, protocols, and procedures.
Serve of committees and work groups upon request.
Performs other duties that may be assigned from time to time.