Credentialing Specialist

Job Description

Job Description

JOB DESCRIPTION: With assistance and oversight from senior team members, the Credentialing Specialist is responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process for outpatient office providers and Recovery Center providers. Works with administration to ensure interpretation and compliance with the appropriate accrediting while developing and maintaining a working knowledge of the statues and laws relating to credentialing.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Duties and responsibilities of the credentialing specialist are:

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
• Maintain internal provider grid to ensure all information is accurate and logins are available
• Work with providers to apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete revalidation/re-credentialing requests issued by government and commercial payers
• Credential/Privilege new providers and re-credential current providers within outpatient/ hospitals as needed
• Work closely with the Chief Financial Officer and billing office to identify and resolve any denials or authorization issues related to provider credentialing
• Maintain accurate provider profiles on credentialing and HRIS softwares.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
  

QUALIFICATIONS:

• Must have at least a High School Diploma or G.E.D.
  
• Two years of experience in the medical industry preferred.
  FQHC Experience preferred.
  Experience with multiple NPI numbers preferred.
• High Volume Data Entry Experience required.
  
• Credentialing experience required.
  
• CPR Certification required.

COMPETENCIES:

• Leadership.
  
• Critical Thinking.
  
• Learning Orientation.
  
• Ethical Conduct.
  
• Collaboration.

PHYSICAL DEMANDS:

Physical demands described are representative of those that must be routinely met by and employee to successfully perform the essential duties of this position.  Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essentials duties.

• Ability to lift minimum 25 pounds.
  
• Ability to perform job responsibilities in a facility with multiple levels and without elevator or mechanical transportation.
  
• Operates a computer and keyboard.

POSITION TYPE/EXPECTED HOURS OF WORK:

This is a fulltime position. Hours 8am-4:30pm Monday-Friday.

WORK ENVIRONMENT:

This job operates in a corporate office environment. 

WORKING CONDITIONS:

Working conditions described are representative of those that must be routinely met by and employee to successfully perform the essential duties of this position.  Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential duties.

• Involves no regular exposure to blood, body fluids, or tissues, but may require unplanned tasks that involve exposure to blood, body fluids, or tissues.
  
• May be required to come in early or stay late if the need arises.
  
• Smoke-free environment.

This position description is not intended to be a complete list of all responsibilities, duties or a skill required for the job and is subject to review and change in accordance with the needs of Ohio Valley Physicians Inc. and contractual obligations.

Our Mission

Centered in compassion and excellence, we serve to save lives while nurturing stronger and healthier communities for our persons served, employees, and families.

CORE VALUES:  

Moral, Ethical and Behavioral Guidelines

Family: OVP Health is proud to be a family-owned company. We hold ourselves to the highest standards: the family values that are passed from generation to generation. However, at OVP Health we also believe that our coworkers, our persons served and our community are family. That means we will always treat you like family, no matter what health struggle you're facing. 

Quality: In an ever-changing health care industry, our commitment to consistent, high-quality care has been the same since day one. Our highly trained physicians and nurses are constantly striving to provide the latest, most advanced care and treatment to persons served. Our medication-assisted treatment program is fully accredited by CARF (Commission on Accreditation of Rehabilitation Facilities). In everything we do, our goal is to provide persons served and their loved ones with the highest level of care possible.

Community: At OVP Health, we believe in giving back. And our commitment to improving the communities we serve doesn't stop at providing high-quality medical care. After work and on weekends, OVP Health employees can be found volunteering in the community, and we are proud to support a number of nonprofit groups in the areas we serve. 

Integrity: Ethical, responsible health care is a nonnegotiable at OVP Health. We treat our coworkers, our persons served and our communities with honesty, trust and respect and hold ourselves to the highest standards of ethics and professionalism. Earning a patient's trust and loyalty is our greatest reward. 

EEO STATEMENT

OVP Health provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.  In addition to federal law requirements, OVP Health complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.  This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfers, leaves of absence, compensation and training.

OVP Health expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status.  Improper inference with the ability of OVP Health employees to perform their job duties may result in discipline up to and including discharge.