SCHEDULE: Full-time; 36-40 hours per week; Monday - Friday; 8:00 am - 4:30 pm
The Credentialing Specialist performs the primary source verification for credentialing and re-credentialing of provider applications in accordance with departmental policies and procedures and in compliance with facility requirements, applicable State and Federal laws and regulations.
High school graduate or equivalent. Experience working in a medical institution, credentialing or payor enrollment preferred. Knowledge of basic record keeping and filing systems. Demonstrates skill at written and oral communications. Knowledgeable and confident in the operation of various office machines, computers and various computer software programs. Ability to handle a demanding workload. Demonstrated self-motivation. Typing and data entry skills required. Knowledge of Microsoft Office. Computer skills required.
Communicates with facilities regarding provider applications. Sends, receives and processes provider credentialing and re-credentialing applications; monitors applications for completeness and follows up as needed. Conducts primary source verification of credentialing and re-credentialing application per established policies and procedures. Prepares and transmits completed provider applications and other paperwork to facilities timely. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents as indicated. Maintains a working knowledge of facility specific requirements for credentialing providers. Inputs provider application information and credentialing verification activities into the credentialing database. Prepares monthly invoices and sends to accounting department.