Credentialing Specialist - Hybrid

Job Description

Job Description

JOB SUMMARY

Cypress Healthcare Partners located in Monterey is now hiring for a Credentialing Specialist. This is an excellent entry-level opportunity to work in healthcare. We are willing to train the right person! Apply today! The Credentialing Specialist will assure that licensed practitioners are appropriately credentialed, by using existing systems to register and track practitioners. Credentialing involves ensuring educational, experience, licensing, malpractice, practitioner databank search and other requirements before practicing medicine with a group or practice managed by Cypress. This position has the possibility to become a hybrid schedule after the successful completion of your 90 day introductory period.

- ON THE JOB TRAINING WILL BE PROVIDED-

KEY RESPONSIBILITIES & DUTIES:

• Collects background information from physicians to begin credentialing
• Communicates with physicians the steps of the credentialing process
• Prepares mailers and appropriate forms to payers and/or patients.
• Maintains copies of current state licenses, certificates, malpractice coverage, and other required credentialing documents 
• Tracks expiration dates on licenses to send out renew reminders to physicians
• Audits and evaluates processes involved in verifications for physicians’ and allied health professionals’ appointment, reappointment and privilege delineation.
• Ensures that all practitioners are initially cleared through required databanks (e.g., OIG, SAMS, NPDB) and then establishes and follows policies and procedures for subsequent periodic database searches, using the features of eVIPs credentialing software whenever possible.
• Coordinates the processing of practitioner applications. Assures all applications are processed completely and in a timely manner. Strives to simplify the practitioner application process and implement online/cloud application documents when available.
• Generates reports to include insurance approval dates
• Serves as information resource in credentialing to physicians and allied health professionals.
• Maintains copies of current state licenses, certificates, malpractice coverage, and other required credentialing documents, including physician files.
• Ensures the critical timing factors, such as active CA medical license, DEA license and malpractice insurance coverage. Important expiration dates are properly calendared in the eVIPs system, allowing for adequate time to ensure timely renewals.
• Continuously looking for ways to streamline and automate the physician and allied health professional credentialing and payer contracting processes.
• Improves professional growth, knowledge of job to maintain efficiency and effectiveness of Cypress’s Medical Staff and Credentialing Services Department by belonging to professional organizations, attending seminars, and reading journals and publications addressing medical staff activities.
• Possesses working knowledge of state and federal law relating to due process and provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and accrediting organization standards.
• Implements and optimizes use of eVIPs “eStatus” features that will allow select users to access limited information in eVIPs about the status of a Group’s or Practitioner’s credentialing with a payer. This will be particularly useful for clinic registration and front desk staff for dealing with patient questions about whether their physician or the clinic accepts the patient’s insurance.
  
  
  

KNOWLEDGE, SKILLS, AND ABILITIES 

• Must be able to communicate effectively in English, verbally, and written. Additional languages are desirable.
• Excellent customer service and phone etiquette skills.
• Must be able to maintain a high degree of confidentiality and work well under productivity standards.
• Able to prioritize and balance the workload on short and long-term company needs.
• Must be able to work independently and be able to solve problems efficiently and accurately.
• Able to create channels of communication to obtain information necessary to perform job tasks.
• Strong organizational skills with the ability to prioritize a high-volume workload.
• Must be comfortable with Microsoft Word, Excel, PowerPoint, and Outlook. 
• Helpful attitude, positive teamwork spirit with a willingness to help.

 

CREDENTIALS/EDUCATION/EXPERIENCE

• High School Diploma or Equivalent required.

 

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms, and talk or hear. The employee frequently is required to sit. The employee is occasionally required to stand; walk; climb or balance, and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus (e.g., work a telephone, computer, copy machine, fax machine, etc.).