Credentialing Specialist

Daily tasks and responsibilities include, but not limited to:

• Provide support and assistance for new practice setup as needed.
• Assist with the completing and submitting provider enrollment applications.
• Track progress of outstanding applications and communicate with provider relations representatives for follow-up ensuring enrollment completion.
• Maintain accurate and current information in the provider records in credentialing software database and in provider electronic folders.
• Maintain credential files in an orderly and current manner.
• Provide research and administrative support for special projects.
• Ensure HIPAA guidelines are respected by safeguarding protected health information in the capacity of the position and responsibilities.
• Create new credentials electronic files, save provider’s credentials to that file according to Global Share Filing Structure Policy, create new Practice and Provider Data Sheets.
• Provider Credentials:  Maintain current credentials i.e. medical licensure, DEA, COI’s, etc. and set Verity CredentialStream reminders for notification of future expiration dates; maintain Provider Data Sheets with current credentialing information; maintain the credentials spreadsheet for the emergency and urgent care practices.
• CAQH Re-attestation:  Maintain CAQH re-attestation spreadsheet and re-attest as required updating any expired credentials.
• Incoming E-mail, Faxes:  Respond to requests for renewed credentials, W-9s, etc.
• Maintain Electronic Files:  Update provider files with current information, documentation.
• Credentialing Software:  Document all daily activities in Verity CredentalStream and Teamwork.
• Change of Information:  Submit to health plans change of information letters and W-9s regarding practice moves, adding locations, changing remit addresses.
• Follow-up:  Make calls or send emails to health plans and/or medical facilities to check status of applications, change of information letters, or contracts.

 
Important Note: This Job Description is subject to any reasonable adjustment in accordance with the changing and developing needs of the position.

Qualifications and Requirements

• Preferably College Graduate or at least 2 years in College
• Degrees and Courses related to Medical Field is a plus
• Strong written and verbal communication skills
• Ability to work effectively with minimal supervision
• Ability to work with confidential information
• Detail oriented
• Proficient in the use of email
• Highly motivated self-starter
• Organized, able to set priorities and meet deadlines
• Dependable and reliable
• Team player being supportive of Department and Company goals and policies
• Must be flexible with schedule
• Previous call center experience related to Medical Accounts and Programs is a plus