Credentialing Specialist

Credentialing Specialist

Evenflow Solutions has a client that is searching for a goal-oriented and professional credentialing specialist to add to their team.

About the Position

This will be a full-time direct hire position for a great company. This is a full-time remote position for those who currently reside in one of the following states: CO, FL, MA, MI, OR, PA, SC, VA, WY.

Job Summary

The preferred candidate will be extremely organized, able to work independently and conscientiously. The credentialing specialist will be accountable for all aspects of the enrollment, credentialing, recredentialing, and the privileging processes for all medical providers who provide patient care. This person will oversee ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. The credentialing specialist will be accountable for maintaining up-to-date data for each provider in the company's outsourced vendor's credentialing database and online systems and be held accountable for timely renewal of provider licenses and certifications. To be successful at this position, the successful candidate would need to be able to ensure accuracy, confidentiality, and prevalence of all information. The preferred candidate will have the ability to multitask several items and deadlines at once, be reliable and have exceptional people skills.

Essential Functions

To perform this job successfully, he or she must be able to perform each essential duty satisfactorily with a high level of skill and organization. Reasonable accommodations will be made to enable qualified individuals with disabilities to perform the essential functions.

• Acts as the credentialing liaison between providers and Company's outsourced credentialing vendor for timely assistance with the enrollment, credentialing, and privileging processes.
• Works with practice location and surgery center managers, as well as with Company's outsourced credentialing vendor to ensure that all providers are credentialed, enrolled, and privileged as appropriate.
• Coordinates credentialing committees with ASCs and oversees the credentialing process to completion to ensure all providers are current and maintained.
• Interfaces with internal and external customers on enrollment, credentialing, and privileging issues.
• Responsible for provider license and DEA renewals, as well as coordinating the renewal of provider board certification and lifesaving certificates.
• Maintains accurate provider information and affiliations with CAQH, PECOS, NPPES and CMS.
• Performs other job-related duties as assigned.

Enrollment

Engages with Company's outsourced contract management vendor to confirm payor agreements and other payor contracting details Supports the entry of payer and practice location information in Company's outsourced credentialing vendor's credentialing system. Attaches payors to practice locations, as necessary. Confirms and reconciles, in coordination w/Company's outsourced credentialing vendor, that all providers have appropriate practice locations loaded in practitioner data. Initiates credentialing vendor process for new providers to be added to group rosters with payors. Initiates requests for existing providers to add or remove practice locations with payors. Supports Company's outsourced credentialing vendor with payor directory validation requests. Initiates requests to terminate providers with payors. Provides any e-mails/correspondence/ communications received from payors to Company's outsourced credentialing vendor. Supports Medicare and Medicaid Revalidation efforts.

Credentialing

Confirms, reconciles, and maintains providers that should have privileges at ASC locations. Confirms which ASC location each provider has privileges for. Initiates Company's outsourced credentialing vendor's process for new providers to be privileged at ASC locations. Initiates Company's outsourced credentialing vendor's process for existing providers to practice at an additional ASC location. Coordinates package review with committee members. Completes approval of providers for ASC locations through committee module in vendor's credentialing system, as needed. Maintains meeting minutes as documents of record for committee approval, as needed Maintains and confirms accuracy of reappointment dates. Maintains privileging forms

Privileging

Confirms, reconciles and maintains lists of providers with outside privileges. Confirms, reconciles and maintains where providers have privileges. Submits requests for new providers requiring outside privileges. Provides any e-mails/correspondence/ communications received communications received from facilities (privileging-related) to Company's outsourced credentialing vendor. Assists in obtaining information from providers when unresponsive to company's outsourced credentialing vendor.

Position Qualifications

Competencies: Must be extremely organized, methodical, and meticulous in your work product. Excellent attention to detail. Ability to research and analyze data. Ability to communicate effectively, both orally and in writing. Ability to manage a large volume in a fast-paced environment. Knowledge of medical credentialing and enrollment procedures and standards. Ability to work independently. Ability to use independent judgment to manage and impart confidential information. Ability to make administrative/procedural decisions and judgments. Ability to summarize complex issues into digestible summaries for presentation purposes. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. Ability to plan and prioritize daily, weekly, and monthly responsibilities. Must have strong self-discipline and motivation to work in a virtual environment.

• Experience within HIPPA and compliance-sensitive environments.

Ability to convey a positive and professional image to patients and employees at all times. Proficient use of Microsoft office (Word, Excel, PowerPoint). Must be able to create tracking schedules and create simple grids in Excel for summary and presentation purposes.

Education & Experience Requirements

High school diploma or GED required; bachelor's degree preferred. At least 2 years of medical provider credentialing experience within a multiple practice (MSO) model environment. Working knowledge or experience w/Symplr outsourced credentialing services a plus.

Additional Job Details

This is a full-time remote position for those who currently reside in one of the following states: CO, FL, MA, MI, OR, PA, SC, VA, WY. Some travel may be required, as needed and/or necessary. Compensation for this role will be up to $26.00 per hour and will vary based on experience.

Our Employee Perks

PTO Accruals Start at 3 Weeks Comprehensive Medical and Dental Insurance Short Term and Long-Term Disability Insurances Educational Allowance Generous Paid Holiday Program

At least of 2 years of medical provider credentialing experience within a multiple practice (MSO) model environment.

Working knowledge or experience w/Symplr outsourced credentialing services a plus. Must have advanced knowledge of maintaining an accurate provider information and affiliations with CAQH, PECOS, NPPES and CMS.

Experience working in an Ophthalmology or Optometric environment

Very strong computer skills

Attention to detail

Evenflow Solutions (ES) is an Equal Opportunity Employer. ES provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.