Credentialing Specialist

ESSENTIAL DUTIES AND RESPONSIBILITIES (Included but not limited to the following);

• Completes all insurance credentialing and re-credentialing applications for all FHCN providers with various insurance vendors as well as with Medicare and Medicaid; monitors applications and follows-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Compiles and maintains current and accurate data for all providers provider contract files
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Sets up and maintains provider information in online credentialing databases and system.
• Tracks license and certification expirations for all providers to ensure timely renewals.
• Ensures practice addresses are current with health plans, agencies, and other entities.
• Processes applications for appointment and reappointment of privileges to FHCN.
• Tracks license, DEA, and professional liability expirations for appointed FHCN providers.
• Maintains FHCN appointment files, and information in credentialing database.
• Audits health plan directories for current and accurate provider information.
• Ensure compliance with FHCN credentialing policy.
• All other assigned duties.

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge and understanding of the credentialing process.

Ability to organize and prioritize work and manage multiple priorities.

Excellent verbal and written communication

Excellent attention to detail.

Ability to research and analyze data.

Ability to work independently with minimal supervision.

Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.

Proficient use of Microsoft Office applications (Word, Excel) and internet resources.

EDUCATION AND EXPERIENCE

• At least two years of relevant credentialing experience, preferably in the healthcare industry.
• Bachelor's degree in Business Administration or related field of study
• Master’s degree in Human Resources, Business, or related field. (Preferred)
• Certified Provider Credentialing Specialist (CPCS) (Preferred)