Job Details

Job Description

Job: Credentialing Specialist

EEOC: Administrative Support

Status: Non-exempt

Department: Finance

(This job has the flexibility to work from home and work from 32 hours up to 40 in a given week.)

Position Overview:

Under limited supervision, manages and monitors processes and procedures that support the credentialing, re-credentialing, expirables data management, and delegated credentialing contract processes. Oversees all of the credentialing functions including application management and primary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies.

Responsibilities:

• Serves as company liaison with 3rd party payors
• Manages update to date information regarding fee schedules
• Manages and updates credentialing & clinic licensure policies and protocols
• Ensures reports on credentialing status of providers is up to date and accurate
• Defines and implements processes to ensure credentialing is completed and up to date in a timely manner
• Manages process of negotiating new insurance contracts
• Ensures all clinic information is accurate within 3rd party payor directory
• Drives and implement seamless protocols for gathering credentialing data from health care providers

Qualifications:

• High school education required
• Medical practice experience, surgical practice experience preferred
• Excellent verbal and written communication skills
• Efficiency and organizational skills
• Administrative skills
• Computer literacy and adaptive to new technology

PHYSICAL REQUIREMENTS (MediumMax 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, and environmental conditions may vary depending on assigned work area and work tasks.