Credentialing Specialist

Job Information

Title: Credentialing Specialist

Department: Credentialing

Status: Full-Time

Position Classification/Category: Hourly/non-exempt

Location: Corporate Office

Reports To: Credentialing Supervisor

Summary of Position

Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care at Kintegra Health. This role is responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. He/She will maintain up-to-date data for each provider in a credentialing database to ensure timely renewal of licenses and certifications.


Minimum Qualifications

Must be able to sit, stand and walk for long periods of time. Able to read and understand the English language. Able to effectively maintain confidentiality of records and communicate with all levels of personnel. Ability to work independently with minimal supervision. Ability to establish and maintain effective working relationships with providers, management staff, and contacts outside the organization. Must be able to work with multiple changing priorities. Requires excellent organizational, problem solving and critical thinking skills. Must be able to interact with individuals of all cultures and levels of authority. Requires the ability to maintain confidentiality. Must be able to function as part of a team. Excellent attention to detail.

Experience: Experience in knowledge and understanding of the credentialing process. Minimum of (3) three years of experience in a healthcare setting.

Additional skills required: Ability to research and analyze data. Proficient use of Microsoft Office applications (Word, Excel, Outlook) and internet. Excellent verbal and written communication skills including letters, memos and emails

Additional skills preferred: MS Access

Education: A combination of experience and/or education/certification. Minimum 3 years' experience in Credentialing with an Associate-related degree.


Certification(s)/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.

Key Responsibilities

1. Compiles and maintains current and accurate data for all providers.
2. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
3. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
4. Maintains corporate provider contract files.
5. Maintains knowledge of current health plans and agency requirements for credentialing providers.
6. Sets up and maintains provider information in online credentialing databases and systems.
7. Tracks license and certification expirations for all providers and practices to ensure timely renewals.
8. Ensures practice addresses are current with health plans, agencies and other entities.
9. Processes applications for appointment and reappointment of privileges.
10. Tracks license, DEA and professional liability expirations for appointed providers and practices.
11. Maintains providers and practices credentialing status with commercial insurances, Medicaid and Medicare.
12. Completes credentialing and sends to Board of Directors for approval in a timely manner for all providers, midlevel's and assistants
13. Continuously monitors and maintains the FTCA credentialing spreadsheet to be sent in each year correctly for the HRSA grant application.
14. Assists providers with the NHSC Loan process; Maintains and monitors the NHSC Loan site.
15. Compiles and maintains data for volunteers at all practice locations
16. Manage and administer CME (Continuing Medical Education) funds for medical, behavioral health and dental providers.
17. Performs other duties as assigned.

Kintegra Health Core Requirements

1. Patient First - An approach to care that holds primary, the well-being and desires of the patient
2. Build not Blame - Focusing first on finding fault with the process rather than the person
3. Integrity and Honesty - Fostering an acceptance of openness, honesty, and fairness in words, deeds and the use of organizational resources judiciously for both internal and external customers
4. Cooperation and Flexibility - Related to an internal belief that we function as part of an interdependent team with only shared gains or losses thereby committed to assisting whenever possible beyond the prerequisite job description
5. Culturally Sensitive - Always working toward increasing one's ability to understand, communicate with, effectively interact and care for people across cultures, while having an acute awareness of one's own culture.

Kintegra Health is a community sponsored, family-centered provider of health care, health education and preventive care services without regard to the ability to pay. We screen potential employees to ensure alignment with our core requirements followed by the requisite position skills set. In doing so we need staff committed to this mission who do their best to live and work on the characteristics of our core values as we strive to care for ever increasing members of the communities we serve.

Our goals are:

• To provide continuing comprehensive and accessible primary care services to individuals and families of all economic levels within Gaston County.
• To provide primary care services to meet the physical as well as social health needs of individuals and families, promoting health maintenance, providing timely diagnostics, treatment and referral services.
• To emphasize preventive care through patient and community education to help individuals become aware and responsible for their own health behaviors.
• To employ an interdisciplinary team approach in collaboration with other community providers to provide a continuum of appropriate patient/family-oriented care in a cost-effective manner.