Credentialing Specialist

GENERAL SUMMARY:

Responsible for verifying and maintaining the qualifications, licenses, and certifications of healthcare providers to ensure compliance with regulatory and organizational standards to practice medicine within the scope of their licensure and specialty for Nebraska and boarding states. Secures and maintains medical staff appointments at Bryan Medical Centers, additional Bryan Health medical facilities, and non-Bryan Health regional and critical access hospitals throughout the multistate region. Completes and submits payer enrollment applications timely and tracks through completion to ensure revenue capture for Bryan Health.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Secures initial state licensure and maintenance of state licensure for physicians and advanced practice providers (APPs).

3. *Secures initial and maintenance of state applicable federal DEA registrations and state controlled substance numbers for applicable physicians/APPs.

4. *Facilitates the initial medical staff appointment and reappointment application process for physicians/APPs at Bryan Medical Center, additional Bryan Health medical facilities, and non-Bryan Health regional and critical access hospitals.

5. *Communicates and routes information timely for completion/signature to physician/APP staff to complete the credentialing/payer enrollment/medical staff appointment-reappointment process.

6. *Initiates and facilitates the payer enrollment process for new physicians/APP's and re-enrollment of physicians/APP's with government and contracted payers/insurance companies.

7. *Maintains centralized database of all provider licensure/registrations/payer enrollments/medical staff appointments.

8. *Maintains and tracks physician continuing medical education hours required for applicable state licensures in a centralized database.

9. *Acts as point person/liaison for revenue cycle staff, payers, vendors and external clients/facilities related to any credentialing duties/requirements/needs/discrepancies.

10. *Maintains strict confidentiality of personal information/legal information/practice history information of physicians/APP's.

11. Resolves problems/issues independently using sound judgement and following established departmental guidelines in a timely manner and escalates to manager when necessary.

12. Provides support in various areas within the Bryan Health revenue cycle.

13. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

14. Participates in meetings, committees and department projects as assigned.

15. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "*". Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

EDUCATION AND EXPERIENCE:

High school diploma or equivalent required. Associate or bachelor's degree in a healthcare or business-related field preferred. A minimum of six (6) months credentialing experience or one (1) year healthcare experience is preferred.