Description

Join Cornerstone Care and make a difference! 

We are seeking a detailed oriented professional to join our team as a Credentialing Specialist. 

Responsible for all aspects of the initial credentialing, re-credentialing, privileging and overseeing the credentialing portion of the new hire on-boarding process for all incoming providers. Overseeing the application process includes maintenance of the online application site and forms repository and intake, review and appropriate routing of all credentialing documents. Responsible for the insurance/billing and facility credentialing. This position liaises with both internal and external agencies involved in the credentialing process. Also liaises with programs, hospitals and applicants regarding any required follow up or notification. This position will be a lead in the creation of the credentialing system. In addition to credentialing of providers, position will maintain certifications, licenses, DEAs and CMEs for medical staff.

JOB DUTIES AND RESPONSIBILITIES:

The following statements are intended as general examples of the duties of this position and are not all-inclusive for specific positions. Other reasonable duties may be assigned.

• Maintains credentialing and competency files in an organized manner and ensures they are current 
• Ensures appropriate boards and certifying agencies are contacted to validate current and accurate information is maintained on an ongoing basis 
• Ensures documents are filed timely and accurately in the credentials and competency files 
• Enters data in the credentialing management system is completed timely and accurately 
• Prepares information for appropriate review 
• Ensures credential files are in order with any issues of concern denoted 
• Prepares applicant summaries for regular review 
• Assists with research and preparation of documents to support development of clinical privilege criteria 
• Prepares for internal and external audits conducted for current and accurate provider information 
• Assists with projects related to credentialing and privileging functions and maintains institutional tracking system of privileges 
• Reviews and interprets applicable accreditation, licensure, and other regulatory requirements to ensure the organization's policies meet requirements 
• Maintains confidentiality of credentialing information 
• Handles release of confidential credentialing information in accordance with appropriate guidelines 
• Maintains certifications (ACLS, BLS, PALS. Etc.), CMEs, Licenses and DEAs for all medical staff 
• Ensures records are kept in accordance with the Federal Tort Claims Act (FTCA) and maintains compliance with all of those who are classified as other than providers, including Other Licensed Clinical Providers (OLCPs), Residents and Other Clinical Staff
• Maintains spreadsheets for VISA renewal dates. Forwards updated information to Pennsylvania Medical Assistance 

• Ensures all new providers are credentialed with all insurance payers in a timely manner 
• Ensures the PA Dept. of Health has current physician rosters and collaborative/prescriptive agreements for CRNPs on file and supervising physician agreements for PA’s 
• Ensures hospital and skilled nursing facility credentialing and re-credentialing is completed in a timely manner
• Oversees any delays in credentialing that may occur caused by insurance companies and contacts insurance companies to have claims paid retroactively, where possible 
• Designs and update forms and checklists, including but not limited to, application forms, clinical privilege documents, checklists, etc. 
• Improves professional growth and knowledge related to job-specific competencies 

• Will work in an office environment and may be able to work some remotely
• Must have the ability to manage multiple projects simultaneously
• Must have excellent customer service skills and have the ability to dive results
• Must be detailed oriented and possess strong organizational skills

MINIMUM REQUIREMENTS:

• Bachelor’s degree or equivalent experience, strongly preferred
• Minimum 5 years of experience working in a medical facility environment or healthcare background, strongly preferred
• Working knowledge of medical terminology, insurances and billing
• Experience with electronic medical records
• Excellent communication skills in one-on-one interactions, electrically and over the phone
• Ability to perform the role successfully in a high-intensity environment
• Strong computer skills specifically Microsoft Excel
• Must be a time driven individual who can meet many deadlines with a variety of outside parties
• Must be extremely organized and successfully monitor the status of many concurrent deadlines

Qualifications

Cornerstone Care is a Non-Profit, Federally Qualified Health Center with 13 locations and a mobile unit, serving communities throughout Southwestern Pennsylvania, and Northern West Virginia. Our mission is to improve the health of our patients and all the residents of the communities we serve, with special concern for the medically underserved and low-income populations.

Cornerstone Care offers: Medical insurance, dental and vision coverage, life insurance, long-term disability insurance, 403 B retirement, flexible spending accounts for medical and dependent care, credit union, and a variety of additional voluntary benefits as well as a generous time off package.

Cornerstone Care, Inc is an Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, sex, age, national origin or disability, sexual orientation, gender identity and expression.