What are the responsibilities and job description for the Credentialing Specialist position at Innercare?
JOB SUMMARY: Responsible for all aspects of the credentialing and re-credentialing processes for all medical providers who provide patient care. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
PERFORMANCE REQUIREMENTS:
The duties recorded below are intended to accurately represent the duties of the class and are not intended to cover every single duty of the class and are not intended to cover every single duty of the job.
1. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
2. Maintains knowledge of current health plan and agency requirements for credentialing providers.
3. Sets up and maintains provider information in online credentialing databases and system.
4. Tracks license and certification expirations for all providers to ensure timely renewals.
5. Ensures practice addresses are current with health plans, agencies and other entities.
6. Audits health plan directories for current and accurate provider information.
ADDITIONAL RESPONSIBILITIES:
7. Maintains confidentiality of provider information.
8. Provides credentialing and privileging verifications.
- Operates a variety of office equipment, including computers, printers, typewriters, Copiers fax machine, ten-key calculator, telephone, etc.
- Performs general clerical duties and assists other billing personnel as needed.
- Performs other duties as may be assigned.
EDUCATION AND EXPERIENCE: Any combination equivalent to: graduation from college with an associate’s degree and three years’ experience performing work closely related to the duties and responsibilities of the job.
KNOWLEDGE AND ABILITIES:
1. Knowledge and understanding of the credentialing process.
2. Ability to organize and prioritize work and manage multiple priorities.
3. Excellent verbal and written communication skills including, letters, memos and emails.
4. Excellent attention to detail.
5. Ability to research and analyze data.
6. Ability to work independently with minimal supervision.
7. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
8. Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
PHYSICAL EFFORT: Normal Office Environment.
HIPAA/Compliance.
Maintain privacy of all patient, employee and volunteer information and access such information only on a need to know basis for business purposes. Comply with all regulations regarding corporate integrity and security obligations. Report unethical, fraudulent or unlawful behavior or activity.
Job Type: Full-time
Pay: $25.00 - $27.00 per hour
Benefits:
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Schedule:
- 8 hour shift
Work Location: In person
Salary : $25 - $27
