Credentialing Specialist

About This Role

The Credentialing Specialist provides customer service-centered and timely credentialing, re-credentialing, and other necessary provider enrollment activities. This role is crucial for onboarding initial and continued privileges of NorthStar Anesthesia medical providers who care for patients, ensuring all activities comply with organizational and departmental policies and procedures.

Responsibilities

• Perform credentialing activities within organizational and department policies and procedures, as well as applicable federal, state, and accreditation regulatory standards
• Maintain knowledge of current provider enrollment requirements and client medical facility requirements for credentialing of providers
• Initiate credentialing and re-credentialing applications on behalf of providers for submission to client medical facilities and applicable medical billing agencies
• Review provider files, document, and report as applicable to recruiting, operations, and client medical facility representatives of known malpractice claims, NPDB report activity, license disciplinary action, or other activity that may affect medical provider credentialing
• Monitor, collect, and maintain current copies of medical licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers
• Routinely monitor application processing and follow up as required until completion and provider is granted privileges at client medical facilities and applicable documentation is submitted to medical billing agencies
• Report to credentialing manager status of departmental operations and provider credentialing issues of concern
• Document and maintain credentialing activities of medical providers through utilization of department software application system and individual provider files
• Send notifications to client medical facilities and medical billing agencies regarding provider changes, including name changes, privilege resignations, and terminations
• Establish and maintain customer service-centered and productive working relationships with medical providers, peers, department partner teams, management staff, and contacts outside the organization
• Promote NorthStar Anesthesia
• Demonstrate regular, reliable, and predictable attendance
• Perform other duties as required

Requirements

• High school diploma or equivalent
• Minimum of three years of work-related experience in the field of medical provider credentialing for medical facility fulfillment

Nice to have:

• Associates degree or equivalent
• CPCS certification

Important Details

• Work site attendance may be required from time to time in accordance with business conditions