Credentialing Specialist

The Credentialing Specialist is responsible for all credentialing activities and initial analysis of new contracts.

Essential Functions:

• Responsible for the oversight of all credentialing activities. This includes completion and submission of applications and following up with providers and payors on incomplete items.
• Works with payors to add new locations to existing contracts.
• Maintains good working relationships with payor contacts.
• Performs initial review of new payor contracts and suggests changes to discuss with Director.
• Acts as a credentialing resource for providers.
• Ensures department operations are performed in an accurate and timely manner.
• Identifies and suggests process improvement goals to support operations.
• Develops and maintains partnerships across all other departments, partners, and vendors to develop and integrate solutions in support of business objectives.

Non-Essential Functions/Other Duties:

1. Performs other duties as assigned

Supervisory Responsibility:

Leads, coaches, and mentors Billing & Authorization Staff.

Travel Required: Occasional travel may be required.

Physical Demands:

This is largely a sedentary role, with frequent sitting and computer keyboarding required. Employee will be required to sit, talk, hear, type and write. Occasional bending, squatting, stooping, and lifting (up to 35 pounds) are required.

Qualifications:

Education:

• At least a Bachelor’s Degree in a healthcare or business related discipline, or equivalent experience
• Certification is a plus

Experience:

• At least three years of medical insurance, billing or claims experience, preferably in a supervisory capacity
• Previous management level experience preferred

Skills and Competencies:

• Knowledge of medical billing and ICD-10, and CPT coding, as well as knowledge of financial concepts
• Strategic focus, with the ability to identify and execute on key business strategies that will support attainment of overall organizational business objectives
• Ability to effectively lead, coach, manage, mentor and develop others, holding staff accountable as appropriate
• Excellent interpersonal skills, with the ability to communicate effectively with others
• Able to work both independently and be self-directed, as well as being able to perform in a team atmosphere
• Displays professionalism and represents organization in a professional manner
• Strong knowledge of HIPPA privacy and security rules and regulations

attached

• $18.18 to $20.00