Credentialing Specialist

Description

PURPOSE
The Credentialing Specialist is responsible for preparing, submitting, and maintaining enrollment, credentialing and recredentialing, documentation for physicians and other healthcare providers.


ESSENTIAL JOB FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
• Responsible for Compiling and maintaining current and accurate data for all providers
• Responsible for Data entry and maintaining provider information in online credentialing databases and system
(CredentialStream, CAQH, PECOS, and NPPES)
• Responsible for PrimeSource Verification of State license, DEA, and Board certification
• Responsible for Completing provider initial and re-credentialing applications
• Audits applications for accuracy and completeness
• Responsible for revalidation requests issued by government payers
• Responsible for Submitting completed credentialing application and supporting documentation to all requested payers
• Responsible for monitoring application progress and following up with payers as needed until confirmation of "in network"
status has been received
• Responsible for maintaining copies of current state licenses, DEA certificates, malpractice coverage and any other required
credentialing documents for all providers. As well as tracking all state license, DEA, and board certification expirations for all
providers to ensure timely renewals
• Responsible for tracking CME and, sending quarterly updates to providers
• Utilizes strong research skills to gather pertinent information regarding providers
• And all other duties as assigned
KNOWLEDGE, SKILLS, AND ABILITIES
• Familiar with provider credentialing and recredentialing requirements
• Strong analytic computer and software skills
• Excellent interpersonal skills including excellent verbal and written communication skills
• Ability to demonstrate a high degree of trust and confidentiality
• Ability to work independently and assume assigned responsibilities
• Skilled in efficiency, organization, time management, and prioritization
• Ability to be flexible and function well in a fast-paced environment
• Ability to deal with problems involving several concrete variables in standardized situations
• Ability to communicate effectively and relate to people of different cultures
• Ability to handle confidential information

Requirements

QUALIFICATIONS AND EDUCATION REQUIREMENTS:
• High School Diploma and a minimum of 2 years related experience preferred; or at least four years related experience and
training; or an equivalent combination and work experience considered
• Working knowledge of credentialing accreditation regulations, policies, and procedures
• Certified Professional Credentialing Specialist (CPCS) certification preferred
• Payer Provider Enrollment: 1 year (Preferred)
• Healthcare: 1 year (Preferred)

COMPUTER SKILLS:
• Expert level knowledge of Microsoft Office Products.
• Experience with credentialing software preferred.

PHYSICAL WORK DEMANDS:
• Able to sit and work at computer keyboard for extended periods.
• Requires normal, correctable vision and hearing.
• Able to lift and move up to 25 pounds occasionally.

Equal Opportunity Statement
Tenor Health Foundation is an equal opportunity employer committed to maintaining a
respectful, inclusive, and mission-driven workplace. Employment decisions are based on
qualifications, merit, business needs, and applicable law.