Credentialing Systems Specialist

Job Description

Responsible for processing provider initial and reappointment applications. Ensures credentialing processes are completed on time and in compliance with the guidelines of regulatory agencies, including the Kentucky Board of Medical Licensure, Kentucky Board of Nursing and other state licensures, The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA). Collect, review and confirm the accuracy of providers education, licenses, certifications, and work experience. This may involve contacting educational institutions, licensing, certifying boards, and current and previous employers. Monitor expiration dates of malpractice insurance, licenses and certifications to ensure maintenance of providers' credentials. Maintains database of physicians and allied health which includes demographic information, privileges granted and other related information. Prepare and send provider files for annual insurance audits. Verify and assess the credentials of providers to ensure compliance with industry standards and regulatory requirements. Conduct research to remain up to date on licensing and certification requirements. Send and collect annual dues, maintain providers Flu and TB immunizations. Coordinate New Provider Orientation.

SKILLS: Multi-task in a Fast Paced Environment, Attention to Detail, Organization, Teamwork, Communication, Report Writing, Strong Analytical and Problem Solving, Proficiency in Microsoft and Google applications, Work Without Direct Supervision, Be a Self Starter

EDUCATION: Associate's Degree with healthcare credentialing experience preferred or High School diploma with a minimum of three to five (3-5) years of the same work or work considered preparatory to the position is required.

LICENSES, CERTIFICATIONS, AND/OR REGISTRATION:

None required at initial employment but Certified Professional Credentialing Specialist (CPCS) certification is a desired goal for incumbent.

Position Type

Full Time