Credentialing Specialist

Description

Capitol Billing Group has been in business since 1973. The company is a dynamic and growing company looking for an enthusiast and energetic candidate to add to the team. Our commitment to quality care and patient satisfaction means every member of our staff plays a vital role in a patient's journey towards healing.

Capitol Billing Group is looking for an experienced Credentialing Specialist and the position is Part-Time.

Benefits to include: PTO (Paid time off), 401K with company match and Paid Holidays.

                    General working hours: Monday - Friday 8 am-5 pm

ESSENTIAL DUTIES:

1. Verify and maintain accurate records of provider credentials, including licenses, certifications, and malpractice insurance.

2. Process credentialing applications for healthcare providers, ensuring compliance with insurance company and regulatory requirements.

3. Communicate with healthcare providers and insurance companies to resolve credentialing issues and discrepancies.

4. Manage the physician credentialing process, including enrollment with insurance networks and government programs.

5. Coordinate contract negotiations between providers and insurance companies, ensuring terms are in accordance with organizational policies.

6. Monitor and track credentialing deadlines and expiration dates, ensuring timely renewals.

7. Collaborate with internal teams, Capitol Imaging Leadership, and facilities, to ensure smooth credentialing processes.

8. Stay up to date on changes in healthcare regulations and insurance industry standards related to credentialing.

9. Assist with the development and implementation of credentialing policies and procedures to maintain compliance and efficiency.

10. Maintain confidentiality of sensitive provider information and always adhere to HIPAA regulations.

11. Performs other duties as assigned.

Knowledge, Skills & Abilities:

   -     A strong understanding of medical terminology, proficiency in data management and organization, attention to detail.

   -     The ability to work efficiently within regulatory frameworks and compliance standards

   -     Knowledge of healthcare frameworks and compliance standards.

   -     Ability to maintain a professional image including courteous behavior

Education:

   -     High School Diploma Required some college preferred

Experience & License:

   -     2 years minimum

   -     Computer competency in a Windows Operating System environment

   -     General knowledge of Insurance, Managed Care and Government Billing Guidelines

Physical Demands:

   -     Mostly sedentary work

   -     Moderate physical effort (lift/carry up to 25 lbs)

     -      Occasional standing/walking

   -     Occasional reaching, stooping, bending, kneeling, crouching

Vision Requirements:

   -     Far Acuity: ability to see clearly at 20 feet or more

   -     Near Acuity: ability to see clearly at 20 inches or less

   -     Depth Perception: ability to judge distance and space relationships

   -     Field of Vision: ability to see peripherally

   -     Accommodation: ability to adjust vision to bring objects into focus

Working Conditions:

   -     May be exposed to infections and contagious diseases

   -     Occasional exposure to unpleasant patient or unit elements

   -     Contact with patients under wide variety of circumstances

   -     Exposed to unpleasant elements (accidents, injuries, and illness)

   -     Subject to varying and unpredictable situations

   -     Handles emergency or crisis situations

   -     Subject to many interruptions

   -     Occasionally subjected to irregular hours

   -     Occasional pressure due to multiple calls and inquiries

   -     Handles absentee replacement on short notice

Credentialing Specialists must complete a variety of tasks in verifying and maintaining licensure and other information for our healthcare facilities.  The Credentialing Specialist maintains and inputs new information or update existing information regarding, physicians, facilities, equipment and Governmental and Insurance Payer Requirements.   

The candidate should be detail-oriented, an organized decision-maker with the ability to work both independently and in teams. Strong oral and written communication skills are also essential, as these specialists spend a lot of time communicating with doctors, healthcare administrators, higher education institutions and government officials.

Qualifications