What are the responsibilities and job description for the Insurance Credentialing Specialist position at Universal Health Corporation?
Job Summary
Universal Health Corporation (“UHealth”) is a physician owned medical practice who currently operates in multiple states, serving the long-term care and post-acute industries. We as providers believe in providing amazing quality care with fantastic customer service. We are continuously striving to provide a best-in-class experience for our patients and our employees.
A Credentialing Specialist verifies that all medical staff members’ credentials and licenses are valid and up to date. They maintain databases and advise staff members on renewal dates for licenses and credentials to help ensure they can continue to work legally without lapses. They also work to ensure providers have appropriate privileging paperwork for all facilities in which they work.
Level of Responsibility:
Employment with UHealth is of a confidential nature and operates in accordance with federal and state privacy laws and practices (i.e. HIPAA). All work is performed under supervision, but does require the ability to effectively function independently, with flexibility, initiative, maturity and decision-making within the framework of UHealth’s policy and procedures.
Duties/Responsibilities:
- Create and maintain licensing, credentials and insurance records for all providers.
- Conduct research on updated state and federal regulations and policies.
- Provide appropriate paperwork to facilities for privileging.
- Release information to requesting agencies and public inquiries when required by law.
- Develop internal credentialing processes.
- Maintain databases for all providers to appropriately track credentialing requirements.
- Monitor license and credential expiration dates and advise staff members of required “renew by” dates.
- Ensure facilities and staff members are maintaining compliance with regulatory and accrediting institutions.
- Assistant with end-to-end billing process.
- Other duties as assigned.
Required Skills/Abilities:
- Ability to meet strict deadlines
- Attention to detail
- Exceptional organizational skills
- Good communication skills
- Knowledgeable in policies, laws and procedures
- Strong computer skills
- Proficiency in database management
- Willingness to work as a team player
Education and Experience:
- Multi state credentialing experience preferred.
- Minimum of 2 years of experience in provider enrollment, medical billing, or credentialing.
- Strong knowledge of insurance credentialing processes, including Medicare, Medicaid, and commercial payers.
- Proficiency in medical billing software and electronic health records (EHR) systems.
