Job Description

Job Summary:

The Credentialing Specialist is responsible for supporting the Credentialing Department in performing and maintaining timely, accurate and complete third-party payor credentialing for all 2nd Chance providers.

 

This individual will help with department organization, including provider files and filing, mail management, and utilizing and maintaining credentialing files for all providers.  This individual will also participate in adjudicating timely and accurate status information to all 2nd Chance Departments and respond to requests for information regarding the active credentialing status while working closed with the third-party credentialing firm.

 

This individual will consistently maintain the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable.

 

Duties/Responsibilities

  • Assist with credentialing and recredentialing of all 2nd Chance providers.
  • Serves as a liaison between all providers and the 2nd Chance third-party credentialing firm.
  • Handle all Facility credentialing.
  • Manage provider professional insurance procurement and payments
  • Distributes all credentialing mail and electronic mail as needed and directed.
  • Interact with payors via email or telephone to obtain current status and application process information.
  • Respond to external requests for documents.
  • Requests all necessary documents from Practice Managers or Providers.
  • Maintain accurate information for all credentialing files for all providers.
  • Making copies and filing current documents in provider files.
  • Provide timely answers to specific requests for credentialing or hospital privileging status to various IMS sources.
  • Develop and disseminate regular credentialing status reports to appropriate Managers and Directors.
  • Provide timely notification to payors, as directed, regarding provider additions, deletions and/or modifications.
  • Respond timely and accurately to all W-9 requests.
  • Enter all provider data accurately and timely.
  • Extract and distribute reports as requested.
  • Foster departmental organization.
  • Maintain and utilize credentialing files in an orderly manner to favorably support the credentialing process.
  • Perform needed filing and administrative tasks
  • Perform internet or journal searches on applicable regulatory, NCQA, JCAHO, and Insurance Industry requirements and activities as related to credentialing.

 

  • Hours may vary and be outside of normal office hours depending on business needs.
  • Other duties as deemed necessary.

 

 

Qualifications/Skills:

To perform the Credentialing Specialist role successfully, an individual must be able to perform each essential responsibility satisfactorily.  Additionally, the following are representative, but not all-inclusive, of the knowledge, skill, and ability required of the Credentialing Specialist. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Job Requirements:

  • Excellent oral and written communication skills
  • Strong interpersonal skills: Ability to get along well with others; team player
  • Demonstrated ability to maintain confidentiality
  • Strong organizational skills: Able to handle a variety of tasks and prioritize
  • Goal orientation; excellent follow-through
  • Self-motivated; self-started
  • Detail-oriented
  • Pro-active
  • Demonstrates willingness to accept responsibility and accountability for assigned tasks
  • Strong follow-through.

 

Education and Experience

  • High school diploma or GED required.
  • 2-3 years’ experience with payer credentialing
  • CPCS (Credentialing) license preferred

Required: In office regular and consistent attendance is required.