Credentialing Specialist
Community Health Systems
Description JOB SUMMARY:
This position is responsible for establishing, monitoring, and maintaining provider credentialing with employer groups, managed care organizations, insurance companies, medical staff office and physicians. ESSENTIAL DUTIES AND RESPONSIBILITIES:
KNOWLEDGE, SKILLS AND ABILITIES:
This position is responsible for establishing, monitoring, and maintaining provider credentialing with employer groups, managed care organizations, insurance companies, medical staff office and physicians. ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Upholds and supports the mission, philosophy, objectives, policies and ethics of CHSI.
- Protects organization's value by keeping information confidential.
- Carries out and completes the credentialing process for new and existing Providers.
- Monitors, updates and advises supervisors of Provider and clinic licenses to ensure they are kept current.
- Conducts pre-employment data query on Provider applicants.
- Understands and carries out the necessary process to ensure laws and regulations concerning Provider credentialing and clinic licensing are met.
- Queries electronically the National Practitioner Data Bank for initial appointment, reappointments, change in privileges, and temporary privileges for each clinic.
- Processes all initial applications for Medical/Allied Health Professional Staff appointments and clinical privileges to meet clinic operation policies and procedures.
- Maintains up-to-date license and certified Provider database, including medical licenses, drug enforcement administration (DEA) certificates, malpractice insurance, and renewal period expiration dates.
- Communicate with Medical/Dental Directors continually and provides monthly about expiration reports and provide rosters when requested.
- Maintains organized credential files and assists with inspections by regulatory authorities or accreditation surveyors, and ensures that all information meets federal and state guidelines when processing applications.
- Ensures all requests for privileges are processed in a timely manner.
- Ensures credentialing files are kept current and are in compliance.
- Responds to provider inquiries received by letter, phone, email or internal departments.
- Perform all other duties as directed either formally or informally, verbally or in writing.
KNOWLEDGE, SKILLS AND ABILITIES:
- Strong organizational skills and attention to detail; ability to manage multiple responsibilities simultaneously.
- Strong computer skills, with proficiency in Microsoft Office, database software and internet applications
- Well-developed verbal and written communication skills and the ability to work cooperatively with divergent groups
- Keeps abreast of changes in laws and regulatory requirements.
- Must possess good "customer service" including verbal and written communication.
- A high standard of professionalism and professional ethics and conduct is expected in speech, manner, attitude and appearance at all times.
- Possess strong interpersonal skills and ability to work well with others.
- Ability to deal effectively with changing situations and stressful environment.
- Ability to perform tasks related to physical activity to complete the responsibilities of the position.
- Minimum high school graduate or GED
- Associate's degree or equivalent from two-year college or technical school; OR
- Six months to one (1) year related experience and/or training; OR
- Equivalent combination of education and experience
Vacancy posted 4 days ago
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