Credentialing Specialist

Description

Behind every exceptional healthcare team is a credentialing expert ensuring providers are ready to deliver care.

As a Credentialing Specialist, you'll play a vital role in maintaining compliance, managing provider enrollment, and ensuring clinicians are credentialed accurately and efficiently. Join a team where your attention to detail directly supports quality patient care.

Highlands Oncology began in 1996 with three physicians and a desire to change the face of oncology care in our community. Dr. Malcolm Hayward, Dr. Dan Bradford, and Dr. Thad Beck knew that patients do better at home, in the community where they live and work, and where their support system is already in place. In furthering that goal, Highlands has grown with the region from a single location 26 years ago, to 6 locations in Northwest and Northcentral Arkansas today employing more than 800 diverse team members.

As Northwest Arkansas continues to grow, so must the services and providers available in the region. Highlands Oncology is committed to remaining on the cutting edge to ensure our community has access to the very best cancer care. What we have is something quite unique right here in our own backyard with a caring multidisciplinary team focused on treating patients like family.

Job Summary: The Credentialing Specialist, under the general direction of the Credentialing Coordinator, provides administrative, operational, and provider-facing support for Highlands Oncology Group, P.A.'s credentialing, recredentialing, privileging, enrollment, and related provider compliance processes. This position supports the Credentialing Coordinator and Credentialing and Enrollment Analyst(s) by collecting and maintaining required information and documentation, preparing and tracking applications and submissions, monitoring deadlines and outstanding requirements, performing routine verifications, maintaining credentialing systems and records, and following up with providers and other stakeholders.

The Credentialing Specialist performs assigned duties in accordance with established procedures and department direction and promptly escalates deficiencies, conflicting requirements, unusual circumstances, adverse determinations, or matters requiring interpretation or independent judgment to the Credentialing Coordinator or Credentialing and Enrollment Analyst.

Job Duties / Responsibilities:

• Provides administrative, operational, and provider-facing support to the Credentialing Coordinator and Credentialing and Enrollment Analyst(s) in credentialing, recredentialing, privileging, enrollment, and related provider compliance activities.
• Compiles, maintains, updates, and tracks accurate credentialing and demographic information for Highlands providers and facilities in accordance with established procedures.
• Assists with the preparation, completion, submission, and tracking of provider credentialing, recredentialing, privileging, enrollment, revalidation, and related applications and supporting documentation as assigned.
• Tracks application status, deadlines, expirations, outstanding documentation, signatures, attestations, and other requirements and performs timely follow-up to help ensure required submissions are completed by applicable deadlines.
• Proactively communicates with providers regarding outstanding credentialing, privileging, renewal, verification, and documentation requirements through approved communication methods, including in-person communication, telephone, electronic messaging, and text messaging.
• Provides hands-on assistance to providers completing credentialing and privileging paperwork, applications, attestations, renewals, and other required submissions.
• Travels to Highlands locations and other approved locations as needed to meet with providers and assist them with completing required credentialing and privileging activities.
• Assists providers with accessing and navigating credentialing, privileging, licensing, and other required systems and resources and coordinates additional technical or departmental assistance when necessary.
• Maintains current copies of provider licenses, certifications, accreditations, DEA registrations, malpractice coverage, and other required credentialing or regulatory documentation.
• Tracks provider and applicable clinical staff license, registration, certification, and other credential expirations and initiates reminders and follow-up sufficiently in advance of applicable deadlines.
• Assists with applications, supporting documentation, and follow-up related to hospital appointment, reappointment, membership, and clinical privileges.
• Assists with malpractice liability insurance applications, renewals, documentation, and routine communications with insurance carriers as assigned.
• Populates and maintains provider and facility information in internal and external credentialing databases, portals, tracking systems, and records with a high degree of accuracy.
• Performs routine credentialing and privileging verifications, including primary-source verification, as assigned and in accordance with established procedures.
• Supports credentialing activities associated with new provider onboarding by collecting required information, coordinating documentation, assisting providers with required systems, and tracking completion of assigned requirements.
• Maintains credentialing, privileging, provider, facility, and related department records and files in accordance with established recordkeeping and confidentiality requirements.
• Coordinates routine communications among providers, credentialing staff, facilities, payors, licensing agencies, and other stakeholders and routes questions or matters requiring substantive interpretation to the appropriate Credentialing and Enrollment Analyst or Credentialing Coordinator.
• Monitors assigned credentialing activities for approaching deadlines, missing information, stalled processes, or other potential issues and promptly escalates concerns to the Credentialing Coordinator or Credentialing and Enrollment Analyst.
• Follows established department workflows, standards, procedures, and controls and identifies opportunities or recurring issues that may improve the provider credentialing experience, efficiency, accuracy, or timeliness.
• Maintains strict confidentiality and appropriately safeguards provider, organizational, and other sensitive information.
• Provides responsive, professional, and service-oriented assistance to providers and other internal and external stakeholders.
• Performs other duties as assigned consistently with the needs of the organization.

Requirements

Required Skills/Abilities:

• Strong organizational skills and ability to accurately track multiple tasks, deadlines, documents, and follow-up activities simultaneously.
• Strong attention to detail and ability to review work for completeness and accuracy.
• Effective verbal and written communication skills, including the ability to communicate professionally with physicians, advanced practice providers, management, staff, facilities, payors, and other external contacts.
• Strong interpersonal and customer-service skills with the ability to provide patient, persistent, and professional assistance to busy providers.
• Ability to proactively follow up on outstanding requirements and communicate reminders professionally and appropriately.
• Ability to learn and follow established credentialing, privileging, enrollment, licensing, and organizational procedures and requirements.
• Ability to independently complete assigned tasks within established procedures and recognize when questions, deficiencies, or unusual circumstances should be escalated.
• Ability to establish and maintain effective working relationships with providers, management, staff, and external contacts.
• Proficiency with computers, electronic document management, internet-based portals, Microsoft Office or similar productivity applications, telephone systems, and other standard office technology.
• Ability to assist others with accessing and navigating electronic systems and resources while following applicable security and confidentiality requirements.
• Ability to communicate effectively in person, by telephone, electronically, and through approved text-messaging methods.
• Ability to maintain accurate records and appropriately document communications, follow-up activities, and task status.
• Ability to read, understand, and follow written instructions, procedures, application requirements, and correspondence.
• Ability to maintain a high degree of confidentiality and appropriately handle sensitive provider and organizational information.
• Ability and willingness to travel locally among Highlands facilities and to approved provider meeting locations as required.
• Valid driver's license and ability to meet Highlands' requirements for business-related driving.

Certifications/Licenses/Education/or Experience in a related field:

• High school diploma or equivalent required.
• Associate's degree in healthcare administration, business administration, or a related field preferred.
• Previous experience in healthcare administration, medical office operations, credentialing, privileging, provider relations, or a related administrative function is preferred.
• An equivalent combination of education and relevant experience will be considered.

Physical Requirements:

• Sitting for prolonged periods of time at a desk.
• Computer use that requires visual acuity, typing, use of mouse/keyboard, and staring at a screen for extended periods of time.
• Occasionally lifting objects of up to 25 pounds such as files, office supplies, assisting patients when needed, etc.
• Walking and standing for continuous periods around the office or clinic as needed.
• Fine motor skills for tasks like typing, writing, handling small objects or equipment and materials.
• Adequate mobility for daily interactions and traveling between company locations as needed.

Work Environment:

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodation may be provided to enable individuals with disabilities to perform essential functions.
• Due to the nature of our business and the use of radiation and hazardous chemicals, it is imperative that all employees foster a culture and environment of safety.
• Safety Sensitive: In accordance with the Arkansas code this position is designated as a safety sensitive position wherein the employee performing the job duties under the influence may constitute a threat to health or safety.