What are the responsibilities and job description for the Credentialing Specialist - Hybrid position at Community Health and Wellness of Greater...?
Position Summary:
The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required with commercial payers, Medicare and Medicaid.
Essential Functions & Responsibilities:
- Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
- Maintain internal provider grid to ensure all information is accurate and logins are available
- Update each provider’s CAQH database file timely according to the schedule published by CMS
- Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
- Complete re-credentialing applications for commercial payers
- Credential new providers and re-credential current providers
- Work closely with the Finance department and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
- Maintain accurate provider profiles on applicable carrier databases
- Other duties as assigned
Knowledge, Skills and Abilities:
- Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
- Excellent computer skills including Excel, Word, and Internet use
- Detail oriented with above average organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer service skills; communicates clearly and effectively
Education/Experience Required
- High School Diploma or GED
- 2 years credentialing experience preferred.
Aspects of Performance:
- Supports the philosophy of CHWC and complies with the Center’s policies and procedures.
- Maintains confidentiality, adheres to CHWC Corporate Compliance Program.
- Interacts effectively with groups and individuals; open honest communication; addresses issues professionally while directing to the appropriate departments.
- Organizational skills to manage workload efficiently, initiative/ability to prioritize conflicting demands, ability to self-start – work with minimum supervision.
- Exercises judgment in making independent decision within the scope of responsibilities; ability to problem solve and use good judgment on a case-by-case basis.
- Reliable, dependable, and detail oriented.
- Demonstrates enthusiasm and commitment toward job and mission of the agency.
- Ability to act and operate independently with minimal daily direction from manager to accomplish objectives.
- Ability to work cooperatively and collaboratively with all levels of employees, management, and external agencies to maximize performance, creativity, problem solving and results.
- Experience working in a Federally Qualified Healthcare Center (FQHC) preferred.
Additional General Requirements: Professional positive attitude, understanding of customer service principles, trustworthiness, and excellent interpersonal skills.
Job Qualifications/Requirements:
Education: High School Diploma or GED
Experience: 2 years credentialing experience preferred.
Language Skills: Must speak, write, and read English proficiently. Spanish preferred but not required.
Teleworking: This position requires teleworking if requested
