Job Description
Job Description
Seeking a full-time in-person credentialing specialist to join our large pediatric multi-specialty practice. Flexible work hours available.
SUMMARY: Coordinates all functions related to the credentialing and recredentialing of health care providers with both hospitals and payers and maintains provider credentialing files.
DUTIES AND RESPONSIBILITIES:
- Receives and processes all initial credentialing and recredentialing applications.
- Collects all pertinent information from the provider, provider’s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as deemed appropriate.
- Ensures that credentialing and recredentialing of providers occurs on a timely basis in accordance with industry and company standards and criteria.
- Maintains accurate and complete records of each application’s status.
- Enters all provider information into database.
- Prepares all documents to be reviewed by hospital Credentialing Committees
- Maintains all credentialing and recredentialing timelines and schedules.
- Maintains strict level of confidentiality on all matters pertaining to provider.
- Maintains well-organized provider files that are easily reviewed by credentialing committee, outside review bodies, and others.
- Processes approval, denial, or termination letters.
- Performs other related duties as assigned by management.
QUALIFICATIONS:
- Bachelors degree, or associates degree with equivalent experience and training
- 2+ years experience in provider credentialing strongly preferred
- Commitment to excellence and high standards
- Excellent written and oral communication skills
- Ability to manage priorities and workflow
- Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm
- Ability to work independently and as a member of various teams and committees
- Proficient on Microsoft Word and Excel. Experience using credentialing software strongly preferred.
- Acute attention to detail
- Demonstrated ability to plan and organize projects
- Able to work collaboratively with multiple health professionals in a busy and complex environment using tact, diplomacy, and discipline.
- Ability to communicate professionally and effectively in person, on the phone, electronically, or through other means to individuals and groups.