Credentialing Specialist

Essential Functions

• Reviews and completes hospital and payor applications for all health care providers.
• Completes verification forms/letters for outside facilities.
• Maintain billing insurance grid, provider insurance grid and each individual physician’s spreadsheet up to date on current insurance changes.
• Track and maintain physician licensure(s), certification and CME credits.
• Maintain practitioner credentialing files.
• Maintain practitioner electronic file by keeping all applications/licensure current.
• Maintains all renewal applications for both hospitals/insurances.
• Has knowledge of Employee Handbook content along with established policies and procedures.
• Relies on instructions and pre-established guidelines to perform the functions of the job.
• Affords assistance to the Credentialing Supervisor in their job responsibilities/duties when necessary.

Education

• High school diploma/GED or equivalent working knowledge preferred.

Requirements

• Must be able to communicate effectively with physicians, providers, licensing agencies, insurance payors and the public and be capable of establishing good working relationships with both internal and external customers.
• Some knowledge of insurance billing and hospital credentialing a plus.

Knowledge

• Knowledge of the credentialing process.
• Knowledge of computer systems.
• Knowledge of credentialing paperwork and timelines.
• Knowledge of credentialing timelines and regulations.

Skills

• Skill in establishing good working relationships with internal and external customers.
• Skill in organizing daily work assignments for various providers.
• Skill in managing multiple work assignments and set priorities.

Abilities

• Ability to establish good working relationships with internal and external customers.
• Ability to communicate effectively with physicians, credentialing agencies and staff.
• Ability to be organized and efficient in daily work activities/projects.

Environmental Working Conditions

• Normal office environment.
• Some travel within community.

Physical/Mental Demands

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching required.
• Manual dexterity using a calculator and computer keyboard.