Credentialing Specialist

Fresenius Medical Care•Austin, TX

About The Position

The Credentialing Specialist verifies credentialing documentation for all specialties that provide services to the organization's members. The role is responsible for submitting accurate and complete applications within established credentialing turnaround times and following policies and processes that meet state, regulatory, health and safety, and compliance guidelines. The specialist maintains provider records and data integrity, completes payer enrollment and facility applications, and helps prevent credentialing lapses by following up on missing documentation and escalating outstanding items. The position requires little to no travel.

Requirements

High school diploma.
2–4 years of related experience.
Excellent customer and interpersonal skills.
Detail orientation and strong analytical and organizational skills.
Excellent oral and written communication skills.
Strong computer skills, including proficiency with word-processing, spreadsheet, database, and email applications.

Nice To Haves

Previous experience in health insurance.

Responsibilities

Verify and review specialty credentials, including Medicare, education, training, licenses, malpractice or professional liability insurance, CLIA licensure, and facility surveys, as applicable.
Enter provider information and primary-source verification data into the related database.
Create and maintain provider files in compliance with organizational policies.
Complete payer enrollment and facility applications accurately and on time, consistent with department goals and metrics.
Contact pertinent parties to obtain documents needed for credentialing applications, as directed.
Escalate missing items as directed to help meet deadlines and avoid credentialing lapses.
Follow policies, procedures, and work instructions for the credentialing function.
Assist with goals and performance standards management.
Maintain data integrity in the credentialing database and core system records.
Improve efficiency and service while reducing costs.
Obtain a DUNS number and complete the online SAMS application process to activate it.
Complete yearly revalidations and other DUNS-related requests in SAMS, ensuring system information is correct to avoid payment and authorization delays.
Attend required trainings and use training materials, including content, work instructions, and tools.
Develop knowledge of credentialing regulatory and accreditation requirements, including CMS and NCQA.
Monitor expirations monthly and perform quality checks.
Assist with projects assigned by the direct supervisor and perform other duties as assigned.