About This Role
The Credentialing Specialist completes and tracks provider applications, manages renewals, and maintains databases and documentation for healthcare providers. This role suits an organized individual with strong attention to detail and experience in healthcare credentialing.
Responsibilities
- Complete provider applications and reapplications
- Respond to requests from insurance companies for information and documentation
- Follow up with insurance companies and hospitals regarding the status of physician applications
- Notify insurance carriers when a physician joins or leaves the practice
- Track information to promote the speed of processing
- Process change of addresses for each practitioner and practice location
- Manage renewals (medical licenses, DEA's, occupational licenses) for all providers
- Maintain Availity, NPI, and CAQH databases and quarterly re-attestation
- Obtain hospital privileges for providers and re-credentialing
- Maintain a current and accurate contract listing, identifying the credentialing status of all physicians for the plan and updating the SharePoint site information
- Conduct primary source verification of credentials and qualifications
- Verify and validate provider information, including licensure, certifications, and education
- Assist Marketing in identifying all insurance plans by physicians and update the Insurance Plans via the FMC internet for each provider
- Maintain an electronic resource file on each practitioner, which includes copies of current licenses, CME, DEA, malpractice, Board certifications, plan participation, and hospital privilege information
- Assist in process improvement of the credentialing process
- Collaborate with internal teams to resolve credentialing issues or discrepancies
- Perform other related duties as required and assigned
Requirements
- AA Degree required
- Minimum two years of experience in healthcare credentialing
- Knowledge of regulatory requirements and accreditation standards for provider credentialing
- Proficient in MS Office and intermediate in Excel, Word, and Outlook
- Experience in using credentialing software and databases
- Strong attention to detail and ability to maintain accurate records
- Excellent organizational and time management skills
- Effective communication skills, both written and verbal
Benefits
- Employee health insurance covered at 100%
- Dental insurance
- Vision insurance
- Life insurance
- 401k benefits
