Credentialing Specialist

About the role

TeleSpecialists is looking for a Credentialing Specialist III responsible for supporting the credentialing process of our providers by completing and/or processing credentialing applications and proactively monitoring the status of applications and outstanding items to ensure timely completion of credentialing for our providers.

Essential Duties and Responsibilities

• Develop and maintain relationships within the credentialing and licensing teams, other internal departments and/or with our hospital partners
• Performs data entry of physician’s information into various credentialing applications or systems for processing for both initial credentialing and reappointments
• Reviews and analyzes provider’s information for accuracy and completeness
• Conducts regular follow-up on the status of applications, compiling all required outstanding documentation and verifying all data or documents have been received to process applications timely
• Documents within the credentialing and licensing software platform
• Makes leadership aware of any potential issues identified during the credentialing process and works in collaboration with provider to document/resolve the issue
• Delegated credentialing functions
• Primary source verifications
• Preparing credentialing files for review and approval
• Aids in training and mentoring of Credentialing Specialist I’s and II’s
• Identifies opportunities for improvement, leading special projects and implementing process improvement initiatives
• Assists with oversight and performance of the team including quality assurance reviews, compliance with policies and procedures and regulatory requirements

Qualifications

• Bachelor’s Degree or equivalent is preferred
• 3-5 years credentialing experience required
• Certifications such as CPCS or CPCM is preferred
• Experience working in a hospital, physician practice or healthcare setting is required

Knowledge, Skills, and Abilities

• Ability to interact with internal and external customers
• Experience in an administrative or operational support role
• Strong computer skills, being open and able to learn and use new technologies
• Intermediate level skills with Microsoft Outlook, Excel and Word
• Ability to effectively prioritize and execute tasks in a high-pressure environment
• Ability to work independently and proactively in a fast-paced, dynamic environment

Physical Requirements

• Must be able to remain in a stationary position (sitting or standing) for prolonged periods, often up to 75% of the workday
• Needs to occasionally move about inside the office to access file cabinets, office machinery, or shared workspaces
• Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and printer
• Must be able to exchange accurate information with clients and co-workers in person, over the phone, and via digital platforms
• Occasionally moves or transports office supplies, files, or equipment weighing up to 25 pounds
• Occasionally positions self to maintain files in cabinets or access equipment stored in low or high areas
• Requires close visual acuity to perform activities such as preparing and analyzing data, transcribing, and viewing a computer monitor for extended periods