Credentialing Specialist

Job Description

Job Description

Overview

Under the direct supervision of the Credentialing Supervisor, this position is responsible to assist the lead of our credentialing department in 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 supporting our providers who are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. The right candidate will maintain up-to-date data for each provider to ensure timely renewal of licenses and certifications.

Candidate qualifications:

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 and credentialing assignments. 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: Understanding of the credentialing process. Minimum of (1) three years of experience in a healthcare setting or related education.

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 1 year experience in Credentialing or a minimum of an Associate related degree.

Certification(s)/Licensure: Certified Provider Credentialing Specialist (CPCS) is not required, but a plus.

Key Responsibilities

• Compiles and maintains current and accurate data for all provider and performs other duties as assigned.
• Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Maintains corporate provider contract files.
• Sets up and maintains provider information in online credentialing databases and system.
• Tracks expired licenses and certifications for all providers and practices to ensure timely renewals.
• Processes applications for appointment and reappointment of privileges.
• Tracks license, DEA and professional liability expirations for appointed providers and practices.
• Maintains Providers’ credentialing status with commercial insurances, Medicaid and Medicare; performs maintenance of practices credentialing status as assigned by supervisor.
• Completes credentialing and sends to Board of Directors for approval in a timely manner for all Providers, Advanced Practice Providers, and clinical staff as assigned by supervisor. Continuously monitors and maintains the FTCA credentialing spreadsheet to be sent in each year correctly for the HRSA grant application.
• Manage and administer CME (Continuing Medical Education) funds for medical, behavioral health, chiropractic, and dental providers.
• Provides special project support as assigned by supervisor.

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 believe 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.