Credentialing Specialist

MILWAUKEE HEALTH SERVICES SYSTEM•Milwaukee, WI

49d

About The Position

POSITION SUMMARY: The position must ensure timely submission of provider insurance enrollment credentialing applications according to MHSI's payor contracts. Perform various business office functions such as credentialing and re-credentialing of clinical providers, maintaining provider-credentialing files, and assisting providers with obtaining education and training documentation.

Requirements

High School Diploma or equivalent and five years of related experience required.
Minimum of Five (5) years of healthcare administrative office experience and experience with provider credentialing process preferred.
Excellent verbal and written skills as well as presentation skills.
Must provide excellent customer service skills and can prioritize, delegate, and manage multiple priorities.
The Individual needs to lead and develop staff to achieve their fullest potential and have the ability to manage and lead a diverse team.
Comprehend and use primary written or spoken language to communicate information and ideals.
May vary based on Organizational need.

Nice To Haves

An associate or bachelor's degree in business administration is a plus.

Responsibilities

Monitor process to ensure timely internal responsiveness and compliance with auditor's requests and deadlines, including timely completion and accuracy of product.
Ensure the validity of provider credentials through National Practitioner Databases.
Guarantee accuracy and validity of provider credentials, including state licensure, Federal DEA, Malpractice information, hospital affiliations, and education and training.
Create and manage accurate and current healthcare provider Credentialing files.
Coordinate with providers the completion of credentialing enrollment packets for submission to state, federal, and commercial payors.
Maintain a detailed re-credentialing schedule that ensures continued provider participation with state, federal, and commercial payors.
Work directly with Chief Financial Officer, Chief Medical Officer, and Human Resource Manager to provide guidance and information on provider credentialing.
Work closely with credentialing personnel to continuously improve the credentialing policies and procedures manual. Perform claims follow-up with county, state, federal, and commercial payors.
Coordinate and manage the insurance payor contracts for the organization and third-party payors.
Participate in billing and related activities as requested.
Develop policies and procedures where required.