Credentialing Specialist

Overview

The person in this role is responsible for performing background checks, organizing credentialing documentation, gathering information in relation to on-boarding and working closely with healthcare providers and facilities.

Responsibilities

• Perform background checks and organizing of credentialing documents for new and existing healthcare providers.
• Gather provider credentials, drug screens and any other items related to the onboarding process.
• Complete insurance enrollment for providers in multiple specialties.
• Provide credentialing information to nursing facilities.
• Track expiring credentialing documents, obtain from provider and distribute as needed.
• Maintain One App program to track applications and expirations.
• Actively supports and complies with all components of the compliance program, including, but not limited to, completion of training and reporting of suspected violations of law and Company policy.
• Maintains confidentiality of all information; abides with HIPAA and PHI guidelines at all times.
• Reacts positively to change and performs other duties as assigned.

Qualifications

• High school graduate required.
• 1+ years of office administration experience in a medical office.
• 2+ years of credentialing experience; Medicare and Medicaid a plus.
• Requires flexibility to move within different departments, workflows and tasks as needed.
• Strong knowledge of and skill in the use of a PC and other office equipment (copier, scanner, fax, etc.).
• Strong Windows, Excel, Word and internet applications knowledge – SharePoint experience is a plus.
• One App software preferable but not required.
• Experience with CAQH documentation and functionality is a plus.
• Ideal candidate must be highly self-motivated with the ability to implement and manage cross-functional activities.
• Strong organization and excellent follow-up skills.
• Ability to interact effectively with a variety of people including physicians and facilities.
• Provide high level of customer service for both internal and external candidates.
• Strong written and verbal communication skills.

We will only employ those who are legally authorized to work in the United States. Any offer of employment is conditional upon the successful completion of a background investigation and drug screen.

We are an equal opportunity employer.