Credentialist Specialist

Spectrum of Hope•Houston, TX

About The Position

At the highest level, all employees of Spectrum of Hope must be enthusiastic, entrepreneurial, and committed to performing their job in an ethical and proper manner. The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by commercial payers, Medicare and Medicaid, etc.

Requirements

Enthusiastic, entrepreneurial, and committed to performing their job in an ethical and proper manner
Ability to read, analyze, and interpret common information, reports, and other documents
Ability to respond to common inquires or complaints from customers, regulatory agencies, or company representatives
Ability to effectively present information to management
Communication skills
Technological skills
Attention to detail and analytical skills
Research skills
Customer service skills
Knowledge of medical terminology
Knowledge of CMS. Medicaid Programs of Texas and credentialing regulations and/or the ability to research
GED, high school diploma, or any suitable equivalent
A minimum of 2 years of credentialing experience with hospital medical staff
Knowledge of medical credentialing procedures
Understanding of medical privileging standards
Proficiency in Microsoft Office Word and Excel
Touch-typing skills expertise
Ability to focus for extended periods

Nice To Haves

Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS)

Responsibilities

Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
Maintain internal provider grid to ensure all information is accurate and logins are available
Update each provider's CAQH database file timely according to the schedule published by CMS
Apply for and renew annually all provider licenses.
Complete revalidation requests issued by government payers
Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
Complete re-credentialing applications for commercial payers
Credential new providers and re-credential current providers
Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
Maintainaccurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
Other duties as assigned