Reporting to the Fiscal and Data Services Specialist, the full-time exempt Credentialing Specialist is responsible for collecting, maintaining and preparing documentation that ensures providers are properly trained, licensed and certified as mandated by state and federal regulations.
- Responsible for credentialing and privileging of all medical providers, dentists, and other licensed and certified staff.
- Coordinates medical and dental plan enrollments and hospital privileges.
- Ensures timely medical and dental plan revalidations for providers, dentists, and Grace Health.
- Responsible for provider and dentist license applications and renewals.
- Query’s and monitors National Provider Databank for applicable staff.
- Serves as Point of Contact for National Health Service Corps loan repayment program, runs time and attendance reports and ensures timely submission of applications.
- Processes and tracks Worker’s Compensation claims.
- Maintains OSHA recordkeeping forms.
- Maintains general knowledge of industry trends and employment legislation and ensures compliance.
- Manages internal users of outside electronic health records systems.
- Consistently reviews the Credentialing and Privileging Policy and Procedure and makes changes to comply with HRSA requirements and internal processes.
- Roster providers in CAQH, and other plan required sites, including initial and ongoing maintenance (re-attestations, tracking and updating expiring credentials);
- Review and ensure credentialing and privileging files are completed and accurate, working directly with human resources and providers.
- Compile privileging binders for review/approval.
- Ensure Honor Community Health facilities and providers are credentialed, and re-credentialed properly with Medicare, Medicaid, and commercial plans according to each payors individual requirements and addresses/corrects discrepancies as requested by payors and Revenue Cycle Manager;
- Conduct all follow-up steps until payor approval/completion is obtained;
- Address enrollment disconnects in regards to facilities and providers;
- Prepare customized reports showing provide par status and application progress, facility and provider plan effective and term dates, and plan assigned ID number(s)
- Build a relationship with plan representatives and keep organized files of completed documentation.
- Monitor staff credentials and licenses.
- Performs other duties as assigned. During a public health emergency, the employee may be required to perform duties similar to but not limited to those in the job description.
EDUCATION: High school or GED required, post-secondary education in General Business or Health Care preferred.
- Provider credentialing and re-credentialing knowledge preferred.
- Previous experience in an administrative role is preferred.
- Excellent verbal and written communication skills, attention to detail and high level of customer service skills.
- Must be able to communicate effectively.
- Federally Qualified Health Center experience preferred, but not required.
OTHER REQUIREMENTS: Commitment and passionate about providing health care to individuals and families in medically underserved communities ● willingness to be flexible ● results driven ● ability to deal with sensitive information in a highly confidential manner ● effective communication skills, both written and oral with patients, staff, visitors, co-workers, community partners, funders and other regulatory agencies ● innovative thinker ● effective problem solver ● attentive to details ● able to work in a fast paced environment ● self-starter ● takes initiative ● able to interpret data ● able to use software to generate reports.
Apply at: https://honorcommunityhealth.org/careers/