Credentialing Specialist- 32 Hours

St. Elizabeth Healthcare•Erlanger, KY

About The Position

Reports to the Credentialing Manager, the Credentialing Specialist verifies and maintains healthcare providers' qualifications (licenses, education, certifications, work history) to ensure compliance with regulations, payer requirements, and organizational standards, managing the end-to-end process from initial application to ongoing recredentialing for accurate documentation, timely onboarding, and proper reimbursement.

Requirements

Minimum: High School Diploma
Minimum 1-year experience in provider credentialing, revenue cycle or other related field
Ability to manage and prioritize multiple tasks, knowledge of Excel, Word, Outlook and PowerPoint and the ability to learn other computer skills.
Must have good organizational skills and work professionally with doctors, hospital administration and management, SEP employees and the public.
Understanding and knowledge of insurance credentialing application procedures.
Strong organizational skills.
Ability to maintain strict confidentiality, per corporate policies.
Knowledge of computer skills and applications.
Excellent communication skills.
Demonstrated ability to work successfully in a team-based decision-making culture.
Demonstrated ability to work independently resulting in effective outcomes and on-time performance.
Experience in planning and coordinating multi-disciplinary communications strategies, strategic initiatives, and events.
Must respond and follow through to requests from customers promptly.
Must work carefully and precisely with attention to detail.
Must utilize resources wisely.
Performs duties willingly and with initiative.
Shares necessary information so co-workers can do the same.
Cooperates with other departments and work groups.

Responsibilities

Comply with all applicable laws and regulations.
Accurate and timely completion of all new provider applications and re-credentialing applications.
Track and enter provider data into the system.
Electronic files should be complete, current and accurate.
Maintain provider files of credentials, provider numbers and signed contracts.
Paper files should be complete current and accurate.
Accurate and timely information is provided to contract carriers.
Maintain network and billing systems files for provider status.
Effective and timely communication with site and CBO for addressing credentialing issues.
Responsible for submitting Medical License and DEA invoices.
Maintain an accurate and up to date log to ensure timeliness of renewals.
Answer telephones within 3 rings and is friendly and helpful.
Other duties as assigned.