Credentialing Specialist

Credentialing Specialist

Job Classification: Non-Exempt, Part-time

Work Schedule: Monday – Friday 12p - 4p or 12:30p - 4:30p CST- 20 hours/week

Reporting Relationship: Manager of Credentialing Services

Primary Accountabilities:

Responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care for HealthSource and their CMHC partners. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

Major Duties:

• Compiles and maintains current and accurate data for all providers
• Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Maintains corporate provider contract files.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Sets up and maintains provider information in online credentialing databases and system.
• Tracks license and certification expirations for all providers to ensure timely renewals.
• Ensures practice addresses are current with health plans, agencies, and other entities.
• Processes applications for appointment and reappointment of privileges to various hospitals.
• Tracks license, DEA, and professional liability expirations for appointed HIS and CMHS providers.
• Maintains HIS and CMHC appointment files, and information in credentialing database.
• Audits health plan directories for current and accurate provider information.
• Maintains confidentiality of provider information.
• Provides credentialing and privileging verifications.
• Promotes a positive image of HIS by initiating, developing, and sustaining effective business relationships in the communities served.
• Answers and directs all incoming calls to appropriately meet customer needs.
• Helps resolve customer issues, completes customer reviews and identifies customer service trends, determines system improvements, and implements change.
• Advises the leadership team by providing customer service information and recommendations to support leadership initiatives related to quality standards.
• Attracts potential customers by answering service/product questions.
• Participate in training classes as outlined by the division, Human Resources and HIS.
• Suggest, support, and participate in the quality initiatives undertaken by HIS and suggest, support and influence programs within the division or company that refine systems and processes and improve overall performance.
• Performs all other duties as assigned.

Requirements:

Qualifications:

• High School diploma or GED required.
• Associate or vocational degree preferred.
• Certified Provider Credentialing Specialist (CPCS) preferred.
• Two (2) years of relevant credentialing experience preferred.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent verbal and written communication skills including letters, memos and emails.
• Excellent attention to detail.
• Ability to research and analyze data.
• Ability to adapt to changing work priorities and a fast-paced environment while maintaining a professional and positive attitude.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Demonstrated ability to use computer software applications (Microsoft Office suite) and internet resources.
• Ability to work independently on projects and ask for support as necessary.
• Demonstrates poise, tact, and diplomacy with the ability to handle sensitive and confidential information and situations to meet HIPAA standards for confidentiality.
• Must successfully complete background checks.

Physical Demands:

• Constantly required to speak, write, and memorize.
• Constantly required to talk, read, problem solve, see, hear, and sit.
• Push, pull, lift or carry twenty (20) pounds.
• Occasionally required to bend, twist, squat, kneel, stand, walk, or balance.

Additional Duties:

Additional duties and responsibilities may be added to this job description at any time. The job description does not state or imply that these are the only activities to be performed by the employee(s) holding this position. Employees are required to follow any other job-related instructions and to perform any other job-related responsibilities as requested by their