Credentialing Specialist

Role Overview

Summary/Objective:

The credentialing specialist will provide customer service centered and timely credentialing, re-credentialing and other necessary credentialing and provider enrollment activities for onboarding of initial and continued privileges of NorthStar Anesthesia medical providers caring for our patients. Such activities shall be performed in accordance with organization and department policies and procedures.

This position can be performed from anywhere within the United States. Candidates must have reliable internet access and be able to work effectively in a virtual environment. Work site attendance may be required from time to time in accordance with business conditions.

Essential Functions:

• Perform credentialing activities within the organizational and department policies and procedures as well as applicable federal, state and accreditation regulatory standards.
• Maintain knowledge of current provider enrollment requirements and client medical facility requirements for credentialing of providers.
• Initiate credentialing and re-credentialing applications on behalf of providers for submission to client medical facilities as well as to applicable medical billing agencies.
• Review provider files, document and report as applicable to recruiting, operations and client medical facility representatives of known malpractice claims, NPDB report activity, license disciplinary action or other activity that may affect medical provider credentialing.
• Monitor, collect and maintain current copies of medical licenses, DEA certificates, malpractice coverage and other required credentialing documents for all providers.
• Routinely monitor application processing and follow up as required until completion and provider is granted privileges at client medical facilities and applicable documentation is submitted to medical billing agencies.
• Report to credentialing manager status of departmental operations and provider credentialing issues of concern.
• Document and maintain credentialing activities of medical providers through utilization of department software application system and individual provider files.
• Send notifications to client medical facilities and medical billing agencies regarding provider changes, including name changes, privilege resignations and terminations.
• Establish and maintain customer service centered and productive working relationships with medical providers, peers, department partner teams, management staff and contacts outside the organization.
• Promote NorthStar Anesthesia’s Core Values.
• Demonstrates regular, reliable and predictable attendance.
• Performs other duties as required.

Qualifications: • High school diploma or equivalent; associates degree or equivalent preferred. CPCS certification a plus.• Minimum of three years of work-related experience in the field of medical provider credentialing for medical facility fulfillment.

Knowledge, Skills and Abilities: • Proficient in Office 365 and applications (Word, Excel, Teams, Outlook)• Customer service / client focus communication (verbal and written)• Experience with primary sourcing of provider licensure, board certification, NPI, NPDB.• Experience in using a provider credentialing software or provider data management system• Attention to detail and documentation• Work well in a team environment.• Ability to organize and prioritize work and manage multiple priorities.• Professional verbal and written communication skills

About NorthStar

NorthStar Anesthesia is a company of caregivers, founded by an anesthesiologist and a Certified Registered Nurse Anesthetist (CRNA). With more than 4,000 anesthesiologists and CRNAs under its banner, NorthStar partners with more than 280 client sites across over 20 states and counting to deliver a more productive and efficient model of anesthesia care. Its "care team" approach focuses on the provision of high-quality care while measurably improving operating room performance.

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