CREDENTIALING SPECIALIST

Job Description

Job Description

Description:

TITLE: CREDENTIALING AND PAYOR ENROLLMENT SPECIALIST

POSITION TYPE: FULL TIME

REPORTS TO: OPERATIONS MANAGER

FLSA CATEGORY: NON-EXEMPT

DEPARTMENT: ADMINISTRATION

MAIN LOCATION: 3676 PARKER BLVD, PUEBLO, CO 81008

JOB SUMMARY: This position is required to perform all duties of the Credentialing and Payor Enrollment Specialist. This position will be responsible for credentialing individual, facility, and/or ancillary medical providers to ensure all initial credentialing, subsequent credentialing, and internal requirements are met and maintained as required with licensing board, hospitals, certification agencies, training programs and medical groups, practitioners, commercial payers, Medicare, and Medicaid. The Credentialing and Payor Enrollment Specialist also maintains excellent relations and liaison between payers, clinics, and providers to assist in ensuring participation status is managed in a timely and accurate manner.

*** THIS IS NOT A REMOTE POSITION. THE EXPECTATION WILL BE 5-DAYS PER WEEK IN PERSON ***

DUTIES AND RESPONSIBILITIES

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
• Maintain internal provider grid to ensure all information is accurate and logins are available.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Update each provider’s CAQH database file timely according to the schedule published by CMS.
• Apply for and renew annually all provider licenses; Professional, DEA, and Controlled Substance.
• Complete revalidation requests issued by government payers.
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
• Complete re-credentialing applications for commercial payers.
• Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.
• Work closely with the Business Office Manager and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain work area in a clean, sanitized, and organized manner.
• Follows all Infection Prevention policies and procedures.
• Attends annual required company programs and trainings.
• Attends all regular required department and company meetings.
• Maintains strictest confidentiality.
• Performs all other tasks and projects assigned.

Requirements:

*** THIS IS NOT A REMOTE POSITION. THE EXPECTATION WILL BE 5-DAYS PER WEEK IN PERSON ***

REQUIREMENTS:

• High School Diploma or equivalent required.
• Associate Degree preferred.
• At least two (2) years of Medical Credentialing experience.
• At least two (2) years of experience in a medical practice business office role required.
• Extremely knowledgeable of credentialing and the direct impact on the revenue cycle.
• Knowledge of medical terminology.
• Ability to multitask.
• Strong ethical code of conduct.
• Ability to maintain sensitive confidential information.
• Proficiency with computers and EMR software.
• Autonomous, positive mindset and team player.
• Ability to remain motivated with a positive attitude.
• Disciplined, organized, and detail oriented.
• Willingness to learn and adapt.
• Ability to work with all levels of management and staff in a professional capacity.

TYPICAL PHYSICAL DEMANDS

Major activities of this job include sitting for long periods of time, moving from place to place, and light physical effort performed on a level surface. Use of a computer, telephone, writing, and organizational skills. Manual dexterity for use of computer keyboard and calculator, mobility and good vision (includes near acuity and depth perception). May be required to lift and carry items weighing up to 10 lbs., occasionally lift or move up to 100 lbs. with assistance. Requires ability to communicate effectively and have hearing within a normal range. Southern Colorado Clinic will make reasonable accommodations for the known disability of an otherwise qualified individual, unless such accommodations would cause undue hardship to the operation of the Clinic or pose a direct threat to patient or other employees’ health and safety.

*** THIS IS NOT A REMOTE POSITION. THE EXPECTATION WILL BE 5-DAYS PER WEEK IN PERSON ***

TYPICAL WORKING CONDITIONS

Must possess the physical and mental abilities to perform the tasks normally associated with a Credentialing Specialist. The work environment is indoors in an office / medical clinic setting. Frequent exposure to communicable diseases, toxic substances, ionizing radiation, medicinal preparations, moving equipment, and other conditions common to a medical clinic environment. Requires working under stress in emergency situations, meeting deadlines, frequent interruptions, and occasionally may involve irregular working hours.

NOTE: Nothing in this job description implies a contract of employment, nor does it restrict management’s rights to assign or reassign duties and responsibilities to this job at any time. This job description is subject to change at any time.

Southern Colorado Clinic (SCC) is an Equal Opportunity Employer. Our policy is clear: there will be no discrimination on the basis of age, disability, sex, race, religion or belief, gender reassignment, marriage/civil partnership, pregnancy/maternity, or sexual orientation.

We are an inclusive organization and actively promote equality of opportunity for all with the right mix of talent, skills and potential. We welcome all applications from a wide range of candidates. Selection for roles will be based on individual merit alone.

SCC does not accept unsolicited CVs from recruiters or employment agencies. SCC will not consider or agree to payment of any referral compensation or recruiter fee relating to these unsolicited CVs. SCC reserves the right to hire candidates without any financial obligation to the recruiter or agency. All applications must be submitted directly through the job posting or our online portal. Unsolicited CVs sent to hiring managers or via email will be considered property of SCC without obligation to any agency.