JOB PURPOSE: With assistance and oversight from senior team members, the Credentialing Specialist is responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process for outpatient office and acute care providers. Works with administration to ensure interpretation and compliance with the appropriate accrediting while developing and maintaining a working knowledge of the statues and laws relating to credentialing.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Gathers credentials and re-credentialing materials for contracted and full-time providers.
• Reviews and analyzes practitioner applications and reapplications, and accompanying documents,
• ensuring practitioner eligibility.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate
• follow up.
• Prepares credentials file for completion and presentation.
• Responds to inquiries from other healthcare organizations.
• Assists with managed care delegated credentialing audits; conducts internal file audits.
• Monitors the initial process for all Medical/Professional staff and delegated providers. Ensure compliance with rules,
• regulations, policies, procedures, and delegated contracts.
• Performs related duties consistent with the scope and intent of the position.
• Regular attendance.
• Ability to solve mid-level problems with minimal supervision.
• Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers.
• Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
• Other duties may be assigned.

QUALIFICATIONS:

• Excellent organizational skills and attention to detail.
• Extensive knowledge of office management systems and procedures.
• Ability to operate general office equipment.
• Excellent written and verbal communication skills.
• Proficient in Microsoft Office Suite or similar software.
• Ability to maintain confidential information.

EDUCATION AND EXPERIENCE:

• Must have at least a High School Diploma or G.E.D.
• Two years of experience in the medical administration industry.
• High Volume Data Entry Experience required.
• Credentialing experience preferred.
• CPR/BLS Certified.
• Credentialing experience with FQHC, Medicaid and Medicare

PHYSICAL DEMANDS:

Physical demands described are representative of those that must be routinely met by and employee to successfully perform the essential duties of this position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essentials duties.

• Ability to lift minimum 15 pounds.
• Ability to perform job responsibilities in a facility with multiple levels and without elevator or mechanical transportation.
• Operates a computer and keyboard.

POSITION TYPE/EXPECTED HOURS OF WORK:

This is a full-time position, and core hours and workdays are Monday through Friday, 8:00 am to 4:30pm. This position may require evening or weekend work.

WORK ENVIRONMENT:

This job operates in a professional office environment. The work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential duties. The work environment is smoke-free. While performing the duties of this job, the employee is not normally exposed to weather conditions. The noise level in the work environment is usually low to moderate.

EEO STATEMENT

OVP Health Care provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, OVP Health Care complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfers, leaves of absence, compensation and training.

OVP Health Care expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper inference with the ability of OVP Health Care employees to perform their job duties may result in discipline up to and including discharge.