Credentialing Specialist

KIDZ MEDICAL SERVICE.•Coral Gables, FL

16h•Onsite

About The Position

SUMMARY: Coordinates all functions related to the credentialing and recredentialing of health care providers with both hospitals and payers and maintains provider credentialing files.

Requirements

Bachelors degree, or associates degree with equivalent experience and training
2+ years experience in provider credentialing strongly preferred
Commitment to excellence and high standards
Excellent written and oral communication skills
Ability to manage priorities and workflow
Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm
Ability to work independently and as a member of various teams and committees
Proficient on Microsoft Word and Excel. Experience using credentialing software strongly preferred.
Acute attention to detail
Demonstrated ability to plan and organize projects
Able to work collaboratively with multiple health professionals in a busy and complex environment using tact, diplomacy, and discipline.
Ability to communicate professionally and effectively in person, on the phone, electronically, or through other means to individuals and groups.

Responsibilities

Receives and processes all initial credentialing and recredentialing applications.
Collects all pertinent information from the provider, provider’s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as deemed appropriate.
Ensures that credentialing and recredentialing of providers occurs on a timely basis in accordance with industry and company standards and criteria.
Maintains accurate and complete records of each application’s status.
Enters all provider information into database.
Prepares all documents to be reviewed by hospital Credentialing Committees
Maintains all credentialing and recredentialing timelines and schedules.
Maintains strict level of confidentiality on all matters pertaining to provider.
Maintains well-organized provider files that are easily reviewed by credentialing committee, outside review bodies, and others.
Processes approval, denial, or termination letters.
Performs other related duties as assigned by management.