What are the responsibilities and job description for the Credentialing Specialist position at InnovaCare Texas Management Services Company, LLC?
We Are InnovaCare!
InnovaCare Health is a dynamic physician led healthcare provider pioneering change in value-based healthcare. We operate 40 clinics with 1,100 employees who share the mission, vision, and values that drive success in each of the communities we touch. Our goal isn’t just healthcare; it’s about promoting work-life balance and supporting the personal and professional goals of each employee to help them lead their best lives.
We are an organization strengthened by our diversity and inclusion. We strive to make an impact in the community through public health education, outreach, and our philanthropic endeavors that span beyond the doors of our facilities.
As we continue to grow, we want employees, like you, who value improving the lives of those they care for each day. Our practices offer: Women’s Health, Wellness, X-Ray/Ultrasound, Dental, Chiropractic, Urgent Care, Managed Care, and Workers Comp services.
Job Summary
This position assists the medical professionals by verifying licensing, their training, and schooling. Making sure they meet the Federal and State and NCQA standards and requirements of their profession. Filing payor’s applications, making the changes for licenses and certificates for the new providers files and assisting on the Updates of various web sites.
Essential Job Functions
- Assists with change Medical Licenses and DEA Certificates of newly hired Providers.
- Assists updating CVs and gathering all the demographics for the Provider Information forms.
- Verifies licensure, certificates, and training of medical providers.
- Gathers the components of a Credentialing Package for the new Providers.
- Initiates CAQH files ready for new providers National credentialing files.
- Assists with updates regarding CAQH and Healthgrades, along with various other websites.
- Assists with redacting introduction letters and training information for our new providers and their State and National guidelines.
- Processes payors applications for the newly hired providers, and for the applications for renewals
which is every two to three years for existing providers.
- Understands the different requirements of payors and the way these requirements change and
affect credentialing.
- Maintains a “timeline” for provider applications to manage pending files.
- Ensures audits are completed with accuracy and quality.
- Keeps accurate account of all application statuses to assure credentialing completeness.
- Cooperates with all other company teams and their needs for credentialing information.
- Communicates daily (sometimes several times a day) with team and key stakeholders.
- Maintains open communications with office administrators to ensure the exchange of renewed
certificates and licensing.
- Assists with other duties as assigned.
Minimum Required Education, Experience & Skills
- Credentialing: 1 year (Required)
- CAQH: 1 year (Required)
Preferred Education, Experience & Skills
- Good interpersonal skills
- Able to stay in constant communication with the team.
- Able to multitask in a fast-paced environment
- Bilingual in English/Spanish preferred but not required
Physical & Mental Requirements: (check all that apply)
- Required immunizations and vaccinations.
- Ability to lift upwards of 50 pounds.
- Ability to push or pull heavy objects using up to 100 pounds of force.
- Ability to endure repetitive motions (e.g. bending, stooping, reaching, pushing, pulling)
- Ability to stand or sit for extended periods of time.
- Ability to use fine motor skills to operate equipment and/or machinery.
- Ability to properly drive and operate a company vehicle.
- Ability to receive and comprehend instructions verbally and/or in writing.
- Ability to use logical reasoning for simple and complex problem solving.
- Occasionally requires exposure to communicable diseases or bodily fluids.
- Ability to discriminate shades of color when reading a dipstick.
The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.