Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers who deliver patient care at our contracted hospitals. Ensures providers are credentialed, re-credentialed and privileged in a timely and efficient manner. Maintain up-to-date data for each provider in the credentialing database; ensures timely renewal of licenses and certifications. Follows established Standard Operating Procedures (SOP’s); notifications; reference guides; policies and procedures, etc.
Primary Duties and Responsibilities:
- 20%: Facilitates the pre-filling; sending and receiving of accurate and complete credentialing information; tracks and reports progress and performs follow-up activities as needed until provider file is complete.
- 20%: Maintains accurate, complete, up-to-date records with current state license, DEA certificates, malpractice coverage and any other required credentialing and corporate documents (including contracts) for all providers.
- 15%: Validates, verifies, enters and maintains all provider information in credentialing system.
- 10%: Tracks expirations for all provider credentialing documents to ensure timely renewal.
- 10%: Processes and evaluates applications for initial appointment and reappointment of privileges in accordance with the hospital and corporate requirements.
- 10%: Ensures timely issue and reissue of COI through completion of the insurance application for all assigned providers.
- 5%: Escalate concerns regarding the processing of providers; lack of renewals and non-response to management.
- 5%: Travels periodically to assigned facilities to build and maintain positive working relationships with APP hospital MSOs.
- 5%: All other duties as assigned
Knowledge and Experience:
- High school diploma or equivalent required
- Two years of relevant credentialing experience required
- Certified Provider Credentialing Specialist (CPCS) preferred
- Associates degree preferred
Basic computer and keyboarding skills required
- Strong verbal and written communication skills required.
- Research and analyze data to support decision making
- Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources
- Ability to handle and maintain secure files containing sensitive personal information
- Ability to organize and prioritize work and manage multiple priorities
- Ability to work independently with minimal supervision
- Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization
- Ability to follow established work-flows; standard operating procedures and corporate policies and procedures
- Ability to serve as company representative
- Continuously sitting
- Frequent walking, standing, bending, kneeling, and reaching
- Continuous repetitive use of arms, hands and fingers
- Occasional lifting and carrying up to 20 pounds
- High level of mental awareness
- High level of attention to detail
Apply for this Position
Note: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
*INTERNAL CANDIDATES: To be considered for an open position, you must be in good standing (i.e., not on a Performance Improvement Plan) and in your current position for at least six months. You must also meet the minimum requirements for the job and be able to perform the essential functions of the position.