Credentialing Specialist I

The Credentialing Specialist I coordinates and maintains medical service provider insurance plan enrollments, ensuring healthcare professionals and services meet all established federal and state standards. This position conducts the credentialing and re-credentialing provide documentation related to education, training of healthcare practitioners, as well as processes payer enrollment and re-credentialing with various insurance plans.

WHO WE ARE

Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. With 11 ministries and access points across Indiana, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers who provide compassionate, comprehensive care for our patients and the communities we serve.

WHAT YOU WILL DO

• Track and document credentialing status/application status changes routinely with participating and non-participating payers; perform data entry of provider data into credentialing databases.
• Fulfill requests for provider data to health plan organizations.
• Process the re-credentialing of established physicians with commercial, managed care plans, and attestation for CAQH.
• Coordinate and perform administrative activities to process provider payer applications, re-applications, and attestations, including initial mailing, review, and loading into the database tracking system ensuring high-quality standards are maintained.
• Complete application submissions with various payers and conduct subsequent status follow-up activities throughout the process.
• Communicate with internal and external customers, which include bi-weekly calls with operational customers and Payor calls to communicate discrepancies.
• Research denials with internal and external customer issues related to credentialing activities.
• Research the Payor processes and online Payor participation in the Payor plans.
• Inquire, compile, review and submit application file as part of the credentialing and re-credentialing process to make certain healthcare professionals and services meet all established federal and state standards.

QUALIFICATIONS

• Required High School Diploma/GED
• 1 year experience in payer enrollment, credentialing, or a related field within a healthcare setting Required
• 1 year Strong organizational and multitasking abilities, with a keen attention to detail. Excellent communication and interpersonal skills, capable of building relationships with diverse stakeholders. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and experience with electronic health record (EHR) systems. Familiarity with healthcare regulations and payer policies Required

TRAVEL IS REQUIRED:

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.