Provider Credentialing and Licensing Specialist

Knoxville Orthopaedic Clinic is seeking a Provider Credentialing and Licensing Specialist for a full-time, hybrid (remote/in office) opportunity at our Central Business Office in West Knoxville. The Provider Credentialing and Licensing Specialist will be responsible for the onboarding of new providers, completing provider payer enrollment with all contracted plans and/or complete applications for provider privileges at hospitals/ASC. Additionally, the Provider Credentialing and Licensing Specialist will maintain provider data in credentialing software and payer sites to include; renewed documents, additions/deletions, demographics, practice updates, etc. Engage with payers and medical staff offices for required documentation. Additional administrative duties as assigned. Experience in credentialing or provider enrollment required. Strong computer and keyboarding skills with proficiency in Excel and Word. Excellent attention to detail is a must.

Key Responsibilities:

• Track and Monitor Medical Licenses:
• Maintain a system for tracking the expiration and renewal dates of providers' medical licenses across relevant states and jurisdictions.
• Proactively remind providers of upcoming license renewals and assist with submission of renewal documents as needed.
• Facilitate DEA Registration and Compliance:
• Track and monitor the status of DEA registrations for all providers.
• Provide support in facilitating the renewal process for DEA registrations to ensure compliance with federal and state regulations regarding controlled substances.
• Coordinate Board Certification Requirements:
• Keep track of the expiration and renewal schedules of board certifications for providers.
• Ensure timely submission of necessary documents to certifying boards for renewal or recertification.
• Advise providers on certification renewal processes and deadlines to ensure no lapses in certification.

Continuing Medical Education (CME) Management:

• Track CME requirements for each provider based on their specialty, license, and board certification requirements.
• Monitor the completion of CME credits and ensure providers meet the necessary educational thresholds for license and certification maintenance.
• Advise providers on CME opportunities, deadlines, and the documentation needed for compliance.
• Documentation Coordination and Submission:
• Ensure the proper submission of all necessary documentation for medical licenses, DEA registrations, board certifications, and CME credits.
• Coordinate with providers to gather all required documents, including course certificates, renewal forms, and any other compliance-related paperwork.
• Ensure that all documentation is submitted in a timely manner to avoid any lapses in credentialing.
• Provide Reminders and Support:
• Proactively communicate with providers about upcoming renewals and requirements.
• Act as a point of contact for providers to answer questions and provide guidance on credentialing, licensing, and educational requirements.
• Running reports, gathering of fee schedules, scheduling meetings as needed.
• Regulatory Updates and Compliance:
• Stay updated on changes in medical licensing laws, DEA regulations, board certification requirements, and CME standards.
• Advise providers on new regulations or changes to existing credentialing requirements.
• Submission of claims appeals when necessary.
• Collaboration:
• Work closely with the HR, legal, and medical leadership teams to ensure provider credentials are up to date and meet organizational standards.
• Assist with onboarding processes by ensuring new providers meet all credentialing requirements.

Required Qualification and Skills:

• High School diploma or equivalent.
• 2 years of experience in healthcare administration, compliance, or a similar role involving credentialing, licensing, and regulatory tracking.
• Strong organizational skills with the ability to track multiple providers and their respective credentials.
• Excellent communication and interpersonal skills to interact effectively with providers and internal teams.
• Detail-oriented and proactive in ensuring all requirements are met on time.
• Proficient in Microsoft Office Suite (Excel, Word, PowerPoint), Google Workspace and credentialing software/systems.
• Proficient in basic math and analytic problem solving.

Preferred Qualifications and Skills:

• Bachelor’s degree in healthcare administration, business, or a related field
• Familiarity with state medical licensure processes, DEA registration requirements, board certification, and CME (Continuing Medical Education) regulations.
• Certified Provider Credentialing Specialist (CPCS) or a similar credentialing certification.

At Knoxville Orthopaedic Clinic our purpose is to improve lives through patient-centered care; every patient, every time. And we've been doing just that since our practice was founded in 1930. As East Tennessee's largest orthopedic practice with 16 clinics and onsite therapy locations, 54 surgeons, over 1000 employees and have performed over 31K orthopedic procedures, we offer competitive pay and EXCELLENT benefits, such as low cost medical, dental, vision, 401K profit sharing, PTO, and employee discounts.

We are looking for people with a team-first mindset, who want to help others and are motivated by pursuing excellence. Our “Ideal Team Player” excels in building trust through active listening and collaboration, while being humble, hungry and people-smart. “It’s not my job” is not a phrase you’ll hear around here. We’re team-driven, collaboration-minded and all-in, all the time. If this sounds like you, join our team!

Knoxville Orthopaedic Clinic was voted a TOP WORKPLACE for 2021 and 2022 by our employees!!

Job Types: Full-time, Part-time

Pay: $20.00 - $23.00 per hour

Benefits:

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

Schedule:

• Monday to Friday

Work Location: In person

Salary : $20 - $23