Credentialing Specialist

About the Role

The Credentialing Specialist is responsible for verifying submitted credentialing documentation for all specialties that provide services to the organization's members. The incumbent will meet all credentialing turnaround time levels by submitting accurate and complete applications, abiding by all policies and processes to meet state, regulatory, health/safety, and compliance guidelines.

Responsibilities

• Verifies and reviews all related specialty credentials, including Medicare, education, training, licenses, malpractice/professional liability insurance, CLIA licensure, and facility surveys, as applicable.
• Enters all provider information and primary source verification data into the related database.
• Creates and maintains provider files in compliance with the organization's policies.
• Completes payer enrollment and/or facility applications in a timely and complete manner consistent with department goals and metrics.
• Conducts outreach to obtain necessary documents for credentialing applications as directed.
• Escalates missing items to leadership to avoid credentialing lapses.
• Assists in goals and performance standards management.
• Ensures data integrity in the credentialing database and core system records.
• Improves efficiencies and service while reducing costs.
• Obtains and maintains DUNS numbers in SAMS to ensure correct information and avoid payment delays.
• Performs monthly monitoring of expirations and quality checks.
• Assists with various projects as assigned.

Qualifications

• High School Diploma required.
• 2-4 years of related experience.
• Previous experience in health insurance preferred.

Skills

• Excellent customer/interpersonal skills.
• Detail-oriented with strong analytical and organizational skills.
• Excellent oral and written communication skills.
• Strong computer skills, including proficiency in word processing, spreadsheets, databases, and email applications.
• Knowledge of credentialing regulatory and accreditation requirements (CMS, NCQA, etc.).

Physical Demands and Working Conditions

Little to no travel is required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws. EOE, disability/veterans.