CREDENTIALING SPECIALIST

SIGNATURECARE EMERGENCY CENTER MASTER•Houston, TX

1d•$21 - $23•Onsite

About The Position

The Credentialing/Contracting Specialist will be responsible for all tasks associated with physician privileging and medical staff membership credentialing. The Specialist will communicate with outside agencies, including physician offices, hospitals, insurance carriers, and other healthcare agencies as required.

Requirements

Minimum Education: High School Diploma/G.E.D.
Minimum 3+ years of experience with physician and facility credentialing is required.
Maintain strong skills in diplomacy, professionalism, and trustworthiness.
Strong communication skills in both oral and written.
Positive attitude, Team Player, and ability to work independently.
Strong working knowledge of computers and Windows PC applications, such as Excel and Word, including the ability to learn new computer systems and applications.
Ability to manage multiple priorities and projects.
Detail-oriented with a desire to produce work with 100% accuracy.
Excellent analytical and problem-solving skills.

Nice To Haves

Experience with insurance carrier credentialing preferred
Knowledge of EPower and Centricity is a benefit.

Responsibilities

Responsible for internal credentialing of all providers in the practices and external consultants coming to the practices.
Responsible for credentialing facilities with insurance carriers.
Responsible for maintaining complete and up-to-date credentialing files for each provider and every practice to internal defined standards.
Meets with providers to gather, review, and provide guidance on completion of credentialing packets.
Coordinates the accurate input of physician information into CAQH, Medicare, Medicaid, and the internal tracking database.
Responsible for the processing of accurate completion of Texas Standardized Credentialing Applications in MS Word files for each physician.
Responsible for the input of physician documents into the database and the proper maintenance of all necessary documents mandated by the organization.
Continuously verifies the status of CVs, provider licenses, DEA, DPS certificates, and specialty certificates; alerts leadership on any expirables not obtained and any provider who is not responding to open requests.
Continuously tracks renewals of provider licenses, DEA, DPS, and ACLS certificates.
Maintains record-keeping on providers’ CMEs and follows up with them to receive the CMEs they have completed.
Ensures providers’ information is forwarded to the appropriate channels within the organization on a mandated basis.
Completes various provider applications and tracks the status of applications once submitted to all insurance carriers.
Maintains Contact information and provides it to leadership upon hiring of new providers and completion of the credentialing process.
Updates the appropriate departments on the status of providers’ credentialing on Managed Care/Insurances.
Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance.
Perform other duties as assigned by the Director of Operations as necessary.