Credentialing Specialist

ESSENTIAL FUNCTIONS · Reviews and completes hospital and payor applications for all health care providers. · Completes verification forms/letters for outside facilities. · Maintain billing insurance grid, provider insurance grid, and each physician’s spreadsheet up to date on current insurance changes. · Track and maintain physician licensure(s), certification, and CME credits. · Maintain practitioner credentialing files. · Maintain practitioner electronic file by keeping all applications/licensure current. · Maintains all renewal applications for both hospitals/insurances. · Has knowledge of Employee Handbook content along with established policies and procedures. · Relies on instructions and pre-established guidelines to perform the functions of the job. · Assists the Credentialing Supervisor in their job responsibilities/duties when necessary.

EDUCATION · High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE · 3-4 years of Credentialing experience

Requirements

· Must be able to communicate effectively with physicians, providers, licensing agencies, insurance payors, and the public · Must be capable of establishing good working relationships with both internal and external customers. · Some knowledge of insurance billing and hospital credentialing is a plus. KNOWLEDGE · Knowledge of the credentialing process. · Knowledge of computer systems. · Knowledge of credentialing paperwork and timelines. · Knowledge of credentialing timelines and regulations.

SKILLS

· Skill in establishing good working relationships with internal and external customers. · Skill in organizing daily work assignments for various providers. · Skill in managing multiple work assignments and set priorities.

ABILITIES · Ability to establish good working relationships with internal and external customers. · Ability to communicate effectively with physicians, credentialing agencies, and staff. · Ability to be organized and efficient in daily work activities/projects.

ENVIRONMENTAL WORKING CONDITIONS · Normal office environment. · Some travel within the community.

MENTAL DEMANDS · Requires sitting and standing associated with a normal office environment. · Some bending and stretching are required. · Manual dexterity using a calculator and computer keyboard.