Medical Credentialing Specialist

Credentialing Specialist / Lead | OKC, OK

Pay: $20-$24/HR, DOE

***5 Years of Credentialing Experience Required***

Hours: Full-Time, M-F 8a-5p

POSITION SUMMARY- The credentialing specialist will verify the credentials of health care providers in accordance with state and federal standards. This involves verifying the legitimacy of practitioner information with universities, licensing agencies, and certification groups. The credentialing specialist will process enrollment, credentialing and re-credentialing paperwork as required by health plans and government programs. The credentialing specialist should be detail orientated and capable of maintaining a database with up-to-date provider information.

The credentialing specialist should have strong oral and written communication skills. They will communicate regularly with health plans via email and phone to ensure the credentialing status of providers is on track. The credentialing specialist will act as a liaison and communicate directly with providers when additional information or documentation is required for their credentialing.

ESSENTIAL FUNCTIONS

· Verify the legitimacy of practitioner information with universities, licensing agencies, and certification groups

· Complete credentialing and re-credentialing applications for government payers, commercial payers and medical staff offices

· Follow lengthy credentialing processes until effective dates are assigned

· Track and assist with license renewals

· Update and pull reports from credentialing database

· Other tasks to support the credentialing team

QUALIFICATIONS

· Bachelor degree or minimum four years of healthcare experience

· Ability to work in a fast paced environment

· Excellent professional communication skills, both written and verbal

· Ability to work independently, set priorities and meet deadlines

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HS Diploma or Equivalent; Bachelor Degree preferred

4-5 Years of Medical Insurance & Provider Credentialing

* Recruit, screen, interview, or place individuals within an organization. May perform other activities in multiple human resources areas.
* Interpret and explain human resources policies, procedures, laws, standards, or regulations.
* Hire employees and process hiring-related paperwork.
* Maintain current knowledge of Equal Employment Opportunity (EEO) and affirmative action guidelines and laws, such as the Americans with Disabilities Act (ADA).
* Prepare or maintain employment records related to events, such as hiring, termination, leaves, transfers, or promotions, using human resources management system software.
* Address employee relations issues, such as harassment allegations, work complaints, or other employee concerns.
* Review employment applications and job orders to match applicants with job requirements.
* Inform job applicants of details such as duties and responsibilities, compensation, benefits, schedules, working conditions, or promotion opportunities.
* Select qualified job applicants or refer them to managers, making hiring recommendations when appropriate.
* Schedule or conduct new employee orientations.
* Maintain and update human resources documents, such as organizational charts, employee handbooks or directories, or performance evaluation forms.
* Confer with management to develop or implement personnel policies or procedures.
* Contact job applicants to inform them of the status of their applications.
* Conduct exit interviews and ensure that necessary employment termination paperwork is completed.
* Interview job applicants to obtain information on work history, training, education, or job skills.
* Perform searches for qualified job candidates, using sources such as computer databases, networking, Internet recruiting resources, media advertisements, job fairs, recruiting firms, or employee referrals.
* Provide management with information or training related to interviewing, performance appraisals, counseling techniques, or documentation of performance issues.
* Analyze employment-related data and prepare required reports.
* Advise management on organizing, preparing, or implementing recruiting or retention programs.
* Develop or implement recruiting strategies to meet current or anticipated staffing needs.
* Administer employee benefit plans.
* Schedule or administer skill, intelligence, psychological, or drug tests for current or prospective employees.
* Conduct reference or background checks on job applicants.
* Review and evaluate applicant qualifications or eligibility for specified licensing, according to established guidelines and designated licensing codes.
* Evaluate recruitment or selection criteria to ensure conformance to professional, statistical, or testing standards, recommending revisions, as needed.
* Coordinate with outside staffing agencies to secure temporary employees, based on departmental needs.
* Evaluate selection or testing techniques by conducting research or follow-up activities and conferring with management or supervisory personnel.

Salary : $20 - $24