Medical Credentialing Specialist

Credentialing Specialists ensure that medical staff members’ maintain current credentials and licenses to work legally in their field or specialty. These specialists monitor upcoming renewal dates and work with medical staff to advise them of the required steps to maintain their credentials. They also review information on potential new employees to make sure all required licenses and credentials are current before hiring.

Those working as credentialing specialists are informed about the regulations and standards required to achieve and maintain licensure and other credentials. A thorough knowledge of applicable medical policy is also needed.

This specialist is required to be able to manage their workloads effectively to meet set deadlines. Strong computer skills are necessary for the input and maintenance of data, as well as for performing research regarding licensing or credentialing requirements in their area. Interaction with other medical professionals, office personnel, and the public is standard.

Job Duties

· Maintain compliance with all regulatory and accrediting institutions

· Monitor staff credentials and licenses

· Advise staff on renewal procedures

· Participate in the development of internal credentialing processes

· Keep records in licenses, credentials and insurance contracts

· Release information to agencies and members of the public as required by law

· Processes applications for appointment and reappointment of privileges for the hospitals

· Maintains all credentialing files, auditing for current licensure, malpractice coverage, Board

Certifications, NPDB, DEA certificates, CME's, etc.

· Knowledge of insurance guidelines, including HMO, PPO, Medicare, and state Medicaid

· Maintaining up-to-date data for each provider in credentialing databases and online systems including CAQH

· Performs other duties as assigned including Payment Posting, AR and E/M Coder

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Requires full range of body motion including handling and lifting files and documents, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for long portions of the day as well as a valid driver’s license without restrictions. Occasionally lifts and carries items, including patient assistance. Requires corrected vision and hearing to normal range.

The FCH is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

PLEASE SEND ONLY PDF FORMATTED RESUME FILES.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Bachelor's (Preferred)

Work Location: In person