Credentialing Specialist

Primary Duties And Responsibilities

• Compiling and maintaining current and accurate data for all providers
• Data entry and maintaining provider information in online databases and systems (CAQH, PECOS, and NPPES, Availity and any other systems as required.)
• Verification of State license, DEA, and Board certification
• Ensures all required documentation is presented to government payers to receive provisional status to practice and be eligible for reimbursement
• Completing provider initial and recredentialing applications
• Auditing applications for accuracy and completeness
• Submitting completed credentialing and re-credentialing applications and supporting documentation to all requested payers
• Maintaining knowledge of current agency, state, county, and payor requirements for credentialing
• Monitoring application progress and following up with necessary parties/payers as needed until confirmation of “in network” status has been received
• Maintaining copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
• Tracking all state licenses, DEA, and board certification expirations for all providers to ensure timely renewal
• Sending monthly updates to supervisors, program leads, and providers/clinicians
• Utilizing strong research skills to gather pertinent information regarding providers
• Aids in compilation of documents for audits conducted by Regulatory Agencies
• Collaborates and executes Quality Assurance and Compliance Projects and Tasks as a Quality and Compliance Assistant including support of the Council of Accreditation Re-Credentialing Process and other related Quality and Compliance Administrative Tasks.
• Undertakes additional projects and responsibilities as assigned by management to support the overall goals of the organization

Qualifications

• Associate degree and a minimum of 2 years related experience preferred; or at least four years related experience and training
• Working knowledge of credentialing accreditation regulations, policies, and procedures
• Certified Professional Credentialing Specialist (CPCS) certification preferred
• Payer Provider Enrollment: 1 year (Preferred)
• Non-Profit: 1 year (Preferred)

Skills Required

• Familiar with provider credentialing and recredentialing requirements
• Strong analytic computer and software skills
• Excellent interpersonal skills including excellent verbal and written communication skills
• Ability to demonstrate a high degree of trust and confidentiality
• Ability to work independently and assume assigned responsibilities
• Skilled in efficiency, organization, time management, and prioritization
• Ability to be flexible and function well in a fast-paced environment
• Ability to communicate effectively and relate to people of diverse cultures
• Ability to handle confidential information