Credentialing Specialist

Dane Street, LLC

77d

About The Position

The Credentialing Specialist is responsible for screening reviewers for required credentialing and background information, including professional sanctions and criminal background information. The position requires coordination between multiple departments at Dane Street to provide support relating to the information, data, and standards involved in reviewer credentialing. Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

Requirements

• An Associate’s Degree or Bachelor’s Degree is preferred.
• Credentialing experience in a healthcare or insurance setting preferred.
• Knowledge of URAC and relevant State and Federal guidelines.
• Excellent communication skills as well as understanding of medical terminology.
• Critical thinking, ability to manage time efficiently and to meet specific deadlines.
• Computer literacy and typing skills required.

Responsibilities

• Initial Credentialing: Enters reviewer application data, performs online searches of reviewers, conducts primary source verification of reviewer board certifications, licenses, background checks, and malpractice checks. Uploads documents to the electronic reviewer file, produces Judgments page to include comments from the Medical Director. Applies client Do Not Use status as required. Communicates the application status with the Operations team, including when an application is denied by the Medical Director.
• Recredentialing of Reviewers: Sends applications to reviewers, conducts prime source verification of board certifications, licenses, and malpractice checks. Performs online searches of reviewers. Refers reviewers with 'red flags' to the Medical Director for review. Indicates Do Not Use status and Medical Reviewer comments in Judgments document.
• Updating Expired Licenses, Board Certifications, and Workers’ Compensation Registration: Reviews licenses, certifications, and registrations for expiration status.
• Exclusions, Preclusions, Background and Sanction Checks: Creates and receives sanctions check clearinghouse reports and search for each sanction identified. Finds supporting documentation, including court documents or National Practitioner Data Bank reporting. Sends information to the Medical Director for review.
• Reactivating, Deactivating, Do Not Use, Reviewer Contact Data and W9 Requests: Obtains W-9 documents in response to address changes. Clones profiles in the event of a fundamental identifying data change. Removes reviewers from the panel based on client or Operations department requests.
• Editing Fee Schedules: Performs data entry of new fees or updated fees. Obtains new fee agreements as appropriate.
• Participation on the Quality Management Committee: Participates in the Quality Management Committee meetings, which is required by URAC but incorporates Dane Street quality improvement functions. Participation includes requested follow up activities.
• Assist Dane Street Team Members with Credentialing Content: Provides credentialing related advice to leadership and for contracting and Operations functions.
• Other duties & special projects, as assigned and based on business needs.

Benefits

• Medical, dental, and vision coverage for you and your family.
• Voluntary life insurance options for you, your spouse, and your children.
• Other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans.
• Basic life insurance, short-term disability, and long-term disability coverage at no cost.
• Generous paid time off policy.
• 401k plan with a company match.
• Apple equipment and a media stipend for remote workspace.

What This Job Offers

• Education Level: Associate degree