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