Credentialing Specialist

:

STI Computer Services

Advancing the delivery of ambulatory healthcare for clinicians with Service, Technology and Innovation.

Our History, Your Future

Healthcare has become complicated to navigate. Medical practices have become difficult to manage. An innovative company with flexible solutions is needed to guide you through these ever-increasing challenges.

For over 40 years, STI Computer Services has been your healthcare partner providing software and support to thousands of medical practices.

• Since 1979, our mission as a Healthcare Technology Company is to:

  • Provide comprehensive, intuitive Health IT solutions
  • Provide peace of mind and security to clients in the ever-changing, fast-paced world of Healthcare and Information Technology
  • Transform the healthcare landscape by improving the efficiency of small to mid-size medical practices

Did You Know?

STI developed one of the first Practice Management and EMR systems in the country?

• Why STI?

  • Developed one of the first Practice Management and EMR systems in the country
  • With over 40 years of experience, our team has a depth of knowledge and expertise rarely seen in the Health IT industry
  • We pride ourselves on meaningful connections with clients to serve as more than vendors, but as their partners in their success

JOB TITLE: Credentialing Specialist REPORTS TO: Credentialing Supervisor

JOB SUMMARY: The Credentialing Specialist is responsible for credentialing and recredentialing providers contracted with STI for said services. Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers. Credentialing functions include, but are not limited to, processing credentialing applications, updating and maintaining credentialing database in accordance with internal policies and procedures, CAQH maintenance, and complying with applicable state and federal requirements.

DUTIES & RESPONSIBILITIES:

• Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for the payor application process.
• Efficiently perform all aspects of initial credentialing and recredentialing process to ensure current credentials and timely handoff and/or review and approval of practitioner files.
• Respond to all practitioner, client health plan and internal inquiries within 1 business day.
• Maintain electronic data files for CAQH to submit practitioner data, as required.
• Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s).
• Collaborate with participating clients, department manager and/or external agencies to facilitate and ensure smooth hand-off from enrollment completion to billing.
• Submit tasks for invoicing.
• Use critical thinking skills to conduct follow-up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process.
• Actively participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.
• Keep Manager informed of potential credentialing or enrollment issues.
• Perform duties in a timely manner as required by clients and company.
• Be an STI advocate at all times.
• Other duties, as assigned.

JOB REQUIREMENTS:

• High School diploma or GED.
• Experience should include responsibility for medical and professional credentialing processes, policies and procedures and delegated credentialing requirements.
• Must have strong organizational skills.
• Able to work well under tight deadlines and respond to rapidly changing demands and provide efficient follow up.
• Capable and comfortable dealing with sensitive and confidential information with discretion and trust.
• Strong oral and written communication skills.
• Problem solving and analytical skills.
• Computer data entry.
• Proficiency with MS Office Suite.
• Ability to follow instruction and adhere to company policies and procedures.
• Must be a team player and willing to learn and take on new responsibilities.
• Ability to represent STI in a professional manner at all times.