Health Plan Credentialing Specialist

CommuniCare Advantage, a member of the CommuniCare family of
Healthcare Companies, is currently recruiting for a Credentialing
Specialist to perform a variety of functions related to licensing/credentialing
for all physicians at CommuniCare.
Purpose/Belief Statement
The Credentialing Specialist maintains licenses and certificates for all
physicians at CommuniCare and ensures that all personnel and services
adhere to facility and staff policies, department guidelines, regulations, and
government laws. The Credentialing Specialist will be responsible for
enrollment/credentialing activities related to individual and group registration
of providers to allow accurate and timely billing of incurred charges.
Job Duties/Responsibilities

• Ensures timely renewal of licenses and certificates.
• Assembles and processes physician license applications and supporting documents with systematic organization.
• Reviews licensure applications and supporting documents for completeness, accuracy, authenticity, and validity, verifies eligibility, and recommends temporary and permanent license application.
• Conducts online background checks.
• Understands, interprets, and applies current healthcare statutes, laws, and regulations as they pertain to licensure.
• Keeps updated on medical licensing and certification requirements.
• Accurately enters and maintains pertinent information in licensure database for licensure processing and reporting on projects.
• Tracks information related to licensing projects, updates information in a timely fashion, and responds to inquiries with speed and professionalism.
• Counsels and corresponds with physicians, organization stakeholders, and others regarding status of applications.
• Meets project deadlines proactively, and escalates expeditiously if project appears to be off-track.
• Assists physicians with tracking and reporting CME and stipends for CME.
• Utilizes advanced problem-solving skills to resolve issues and conflicts that may arise.
• General office duties including, but not limited to, answering phones, emailing, faxing, making copies, scanning documents, opening and sorting mail, etc.
• Provides other administrative support as needed.
• Other duties as assigned.

Qualifications

• High School diploma or equivalent
• Bachelor’s degree in Accounting, Healthcare Administration, Finance, Business, or related field preferred.
• 1 – 2 years of physician provider licensing experience preferred.

Knowledge/Skills/Abilities

• Able to integrate new responsibilities into current job description when needed.
• Must be proficient in Windows Office Suite (Outlook, Word, PowerPoint, Excel).
• Must be able to learn quickly and work with minimal supervision.
• Must be able to effectively prioritize and execute tasks in a high-volume environment.
• Strong customer service orientation and focus.
• Must be reliable and possess extreme attention to detail and documentation.
• Excellent interpersonal and communication skills, both oral and written.

Benefits
As a CommuniCare employee you will enjoy competitive wages and PTO
plans. We offer full time employees a menu of benefit options from life and
disability plans to medical, dental, and vision coverage from quality benefit
carriers. We also offer 401(k) with employer match and Flexible Spending
Accounts.
About Us
A family-owned company, we have grown to become one of the nation’s largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, to reach out with our hearts and touch the hearts of others. Through this effort we create Caring Communities where staff, residents, clients, and family members care for and about one another.