Credentialing Specialist

Job Type:
Regular

Scheduled Hours:
40

Job Summary:
Reports to the Credentialing Manager, the Credentialing Specialist maintains active credentialing with all managed care organizations. Initiates credentialing for all newly hired physicians. Maintains active hospital privileges.

Job Description:

Job Title: Credentialing Specialist Tier I

BENEFITS:

• Work from home after training, equipment provided
• Paid Time Off
• Medical, Dental, and Vision
• 403b with Match
• Opportunity for Career Growth- Career Ladder Program Tier I-Tier III

DUTIES AND RESPONSIBILITIES:

• Comply with all applicable laws and regulations.
• Accurate and timely completion of all new provider applications and re-credentialing applications.
• Track and enter provider data into the system. Electronic files should be complete, current and accurate.
• Maintain provider files of credentials, provider numbers and signed contracts. Paper files should be complete current and accurate.
• Accurate and timely information is provided to contract carriers.
• Maintain network and billing systems files for provider status.
• Effective and timely communication with site and CBO for addressing credentialing issues.
• Responsible for submitting Medical License and DEA invoices. Maintain an accurate and up to date log to ensure timeliness of renewals.
• Answer telephones within 3 rings and is friendly and helpful.
• Other duties as assigned.

EDUCATION:

Minimum: High School Diploma

YEARS OF EXPERIENCE:

Minimum 1-year experience in provider credentialing, revenue cycle or other related field

LICENSES AND CERTIFICATIONS:


N/A

REQUIRED SKILLS AND KNOWLEDGE:

Ability to manage and prioritize multiple tasks, knowledge of Excel, Word, Outlook and PowerPoint and the ability to learn other computer skills. Must have good organizational skills and work professionally with doctors, hospital administration and management, SEP employees and the public.


OTHER REQUIRED SKILLS AND KNOWLEDGE:

• Understanding and knowledge of insurance credentialing application procedures.
• Strong organizational skills.
• Ability to maintain strict confidentiality, per corporate policies.
• Knowledge of computer skills and applications.
• Excellent communication skills.
• Demonstrated ability to work successfully in a team-based decision-making culture.
• Demonstrated ability to work independently resulting in effective outcomes and on-time performance.
• Experience in planning and coordinating multi-disciplinary communications strategies, strategic initiatives, and events.
• Must respond and follow through to requests from customers promptly.
• Must work carefully and precisely with attention to detail.
• Must utilize resources wisely.
• Performs duties willingly and with initiative. Shares necessary information so co-workers can do the same.
• Cooperates with other departments and work groups.

FLSA Status:
Non-Exempt

Right Career. Right Here. If you have a passion for taking care of the community and are interested in Healthcare, you will take pride in the level of care we provide at St. Elizabeth. We take care of patients and each other.


St. Elizabeth Physicians is an equal opportunity employer and will not discriminate on the basis of race, color, sex, religion, national origin, ancestry, disability, age or any other characteristic that is protected by state or federal law.