What are the responsibilities and job description for the Credentialing Specialist position at KIDZ MEDICAL SERVICE.?
Job Description
Job Description
Seeking a full-time credentilaing specialist to join our large pediatric multi-specialty practice. Flexible work hours available.
SUMMARY : Coordinates all functions related to the credentialing and recredentialing of health care providers with both hospitals and payers and maintains provider credentialing files.
DUTIES AND RESPONSIBILITIES :
Receives and processes all initial credentialing and recredentialing applications.
Collects all pertinent information from the provider, provider’s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as deemed appropriate.
Ensures that credentialing and recredentialing of providers occurs on a timely basis in accordance with industry and company standards and criteria.
Maintains accurate and complete records of each application’s status.
Enters all provider information into database.
Prepares all documents to be reviewed by hospital Credentialing Committees
Maintains all credentialing and recredentialing timelines and schedules.
Maintains strict level of confidentiality on all matters pertaining to provider.
Maintains well-organized provider files that are easily reviewed by credentialing committee, outside review bodies, and others.
Processes approval, denial, or termination letters.
Performs other related duties as assigned by management.
QUALIFICATIONS :
Bachelors degree, or associates degree with equivalent experience and training
2 years experience in provider credentialing strongly preferred
Commitment to excellence and high standards
Excellent written and oral communication skills
Ability to manage priorities and workflow
Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm
Ability to work independently and as a member of various teams and committees
Proficient on Microsoft Word and Excel. Experience using credentialing software strongly preferred.
Acute attention to detail
Demonstrated ability to plan and organize projects
Able to work collaboratively with multiple health professionals in a busy and complex environment using tact, diplomacy, and discipline.
Ability to communicate professionally and effectively in person, on the phone, electronically, or through other means to individuals and groups.
COMPETENCIES :
Problem Solving Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
Customer Service Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
Interpersonal Skills- -Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
Teamwork Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
Planning / Organizing Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
Professionalism Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
Adaptability Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
Dependability Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
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