Provider Onboarding and Credentialing Specialist
About The Position
Pulmonary Medicine Associates (PMA), a medical practice serving the greater Sacramento area since 1973, is hiring a full-time Credentialing Specialist. PMA has more than 80 providers, serves multiple hospitals, and operates two outpatient clinic locations. The position processes provider credentialing and re-credentialing, coordinates collection of application materials, submits insurance, hospital, and malpractice applications, and communicates with applicants, providers, and medical office staff to support timely completion. The specialist also serves as PMA’s liaison to hospitals and insurance companies, follows institution-specific credentialing rules and policies, and prepares related records and reports.
Requirements
- High school diploma or GED.
- An associate degree in a related field or at least 2 years of related work experience in a medical environment.
- Experience with PAVE, PECOS, and CAQH.
- Highly organized.
- Excellent phone etiquette and verbal communication skills.
- Strong customer service skills and ability to establish and maintain effective working relationships with employees, hospitals, insurance companies, and others.
- Excellent attention to detail and ability to maintain accurate records.
- Ability to maintain confidentiality of sensitive information.
- Ability to work independently and manage multiple priorities.
- Good working knowledge of Microsoft Office, including Word and Excel.
- Ability to type accurately at 45 words per minute.
Nice To Haves
- Certified Provider Credentialing Specialist (CPCS) certification.
- Certified Professional Medical Services Management (CPMSM) certification.
Responsibilities
- Process credentialing and re-credentialing applications for PMA health care providers.
- Coordinate with providers to gather licensing information, CVs, peer references, privileges lists, and procedure histories.
- Perform data entry.
- Prepare and submit applications for insurance, hospitals, and malpractice insurance.
- Communicate regularly with applicants, providers, and medical office staff to ensure credentialing is completed efficiently and on time.
- Act as PMA liaison to hospitals and insurance companies.
- Interpret, explain, and follow institution-specific rules, regulations, and policies related to credentialing.
- Prepare related records and reports.
- Perform other related duties as required or requested.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
