Credentialing Specialist

Credentialing Specialist

Responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care, clinics, and facilities within the EyeSouth Partners Network.

• Ensures providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities.
• Maintains up-to-date data for each provider in credentialing databases and online systems; ensures timely renewal of licenses and certifications.
• Manages provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers, clinics, and facilities.
• Maintains corporate provider contract files.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Enters and maintains provider information in online credentialing databases and systems.
• Manages clinical and facility license and certification expirations to ensure timely renewals and regulatory compliance.
• Processes applications for appointment and reappointment of privileges.
• Maintains ASC appointment files and information in credentialing database.
• Audits health plan directories for current and accurate provider information.
• Enhances and standardizes work - flow processes throughout the revenue cycle process to assist in achieving consistency in maintaining the critical success factors outlined in the firms standard operating procedures.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Monitors timeliness and effectiveness of department activities, ensuring that outstanding account receivables are consistent with contracted standards.
• Communicates/facilitates special projects and requests.
• Compiles and prepares various status reports to analyze trends and make recommendations.

Qualifications

• Minimum of 2 years healthcare facility, provider, or payer credentialing experience in a multi-provider environment required.
• Strong ethics and a high level of personal and professional integrity.
• Strong analytical skills.
• Willingness to seek out new methods and principles and be willing to incorporate them into existing practices, and willingness to embrace new technology.
• Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint.
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external.
• Sound judgment in responding to inquiries; understanding when to route inquiries to next level.
• Self-motivated with strong organizational skills and superior attention to detail.
• Ability to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes.
• Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build consensus among cross-functional teams.
• Strong problem solving and negotiation skills.

Benefits

We offer a competitive benefits package to our employees:

• Medical
• Dental
• Vision
• 401k with Match
• HSA/FSA
• Telemedicine
• Generous PTO Package

We also offer the following benefits for FREE:

• Employee Discounts and Perks
• Employee Assistance Program
• Group Life/AD&D
• Short Term Disability Insurance
• Long Term Disability Insurance

We are an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.