Credentialing Specialist HCS

Facility: Administrative Regional Training Center | Full Time | FTE: 1.066667 | Bargaining Unit: Catholic Health Emmaus | Non-Exempt | Days, 7:00 - 17:00

About the Role

The Credentialing Specialist assists with the electronic credentialing and enrollment of providers into relevant CHS insurances. This role involves communicating with providers' staff and insurance companies, collecting, processing, and organizing significant amounts of enrollment data, and overseeing the credentialing process from start to finish.

Responsibilities

• Create individual and group NPIs as needed
• Create group contracts with insurance companies for physician practices
• Correspond with practitioners to sign applications and receive credentialing documents
• Update and attest CAQH on a regular basis
• Request annual Certificate of Insurance (COI) from clients and upload into CAQH
• Complete Medicare and Medicaid re-validations when needed
• Track when Medicare and Medicaid re-validations are required
• Submit completed payer applications to insurance payers
• Follow up with insurance payers to ensure credentialing is progressing
• Create and maintain providers' CAQH profiles
• Remind practitioners of expiring DEA/licensure
• Submit current DEA/licensure to payers and CAQH as needed
• Assist coworkers as a team player
• Maintain updated documents and changes within insurance portals
• Obtain affiliations with nursing homes and hospitals for providers
• Apply for malpractice insurance for providers and approve invoices for payment
• Provide rosters to insurance companies as needed
• Maintain provider Continuing Medical Education (CME) information when requested
• Travel to obtain signatures from providers or to pick up/drop off pertinent paperwork
• Handle incoming and outgoing phone calls from insurances, providers, client managers, practice, and billing staff
• Respond to numerous emails from clients, insurances, office, and billing staff
• Research requests from office and billing staff regarding claim denials, provider out-of-network issues, etc.
• Update provider initial credentialing with location updates, name changes, etc.

Requirements

• A.A.S. Degree or equivalent certificate program (required)
• In lieu of an Associate's degree, a minimum of three (3) years of direct credentialing experience (required)
• Three (3) years of experience in a healthcare-related field
• Web-based credentialing and privileging software experience (preferred)
• Experience with physician credentialing (strongly preferred)

Skills

• Strong Microsoft Office skills (Word, Excel, Outlook)
• Adobe Acrobat knowledge
• Strong critical thinking skills
• High degree of integrity aligned with organizational values
• Ability to multitask
• Strong oral and written communication skills
• Ability to establish priorities and work well under pressure
• High-quality and accurate work production
• Resourcefulness and strong research skills
• Strong interpersonal skills
• Good judgment, common sense, and diplomacy
• Solid organizational skills
• Ability to work independently
• Ability to analyze data and prepare meaningful reports
• Ability to identify, react, and follow through appropriately in credentialing matters
• Confidentiality on all medical staff matters

Working Conditions

Normal office environment with typical heat, light, and safe working conditions. Occasional travel to other CH facilities for staff meetings or training may be required.