Credentialing Specialist HCS

Facility: Administrative Regional Training Cntr Shift: Shift 1 Status: Full Time FTE: 1.066667 Bargaining Unit: Catholic Health Emmaus Exempt from Overtime: Exempt: No Work Schedule: Days Hours: 7:00 - 17:00 Summary: The Credentialing Specialist is responsible for assisting with the process of electronic credentialing and enrolling them into insurances that are relevant to CHS. Communicate with provider's staff and insurances. This requires electronic collection, processing and organizing significant amounts of enrollment data. Oversee the credentialing process in its entirety from start to finish. Responsibilities: EDUCATION 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 Experience Three (3) years of experience in a health care related fieldWeb based credentialing and privileging software experience preferredExperience with Physician credentialing strongly preferred KNOWLEDGE, SKILL AND ABILITY Strong Microsoft Office skills, knowledge of Word, Excel, Outlook, Adobe Acrobat knowledge Strong critical thinking skillsMust have a high degree of integrity that is aligned with the values of the organizationAbility to multitaskStrong communication skills, both oral and writtenAbility to establish priorities and ability to work well under pressureAbility to provide work of high quality and accuracyResourceful with strong research skillsStrong interpersonal skillsGood judgment, common sense and diplomacySolid organizational skillsAbility to work independentlyAbility to analyze data and prepare meaningful reportsAbility to identify, react, and follow through in an appropriate manner in credentialing mattersMust remain confidential on all Medical Staff mattersCreate individual and group NPIs as neededCreate group contracts with insurance companies for physician practicesCorrespond with practitioners to sign applications and receive credentialing documents Update and attest CAQH on a regular basisRequest annual COI from clients and upload into CAQHComplete Medicare and Medicaid re-validations when neededTrack when Medicare and Medicaid re-validations are neededSubmit completed payer applications to insurance payersFollow up with insurance payers to ensure credentialing is moving forwardCreate & maintain provider's CAQH Remind practitioners of expiring DEA/LicensureSubmit current DEA/Licensure to payers and CAQH as neededTeam Player, assisting coworkers when needed Maintain updated documents and changes within the insurance PortalsObtain affiliation with Nursing Homes and hospitals for providersApply for Malpractice for providers, approve invoices for paymentProvide rosters to insurance companies as neededMaintain provider CME information, when requestedTravel to obtain signatures from providers when applicable as well as travel to pick up or drop of pertinent paperworkHandle incoming and outgoing phone call from Insurances, providers, client managers, practice and billing staffRespond to numerous emails from clients, insurances, office and billing staffResearch requests from office and billing staff regarding claim denials, provider out-of-network issues, etc. Updates to provider initial credentialing with location updates, name changes, etc. WORKING CONDITIONS: Normal heat, light space, and safe working environment; typical of most office jobsIndividual may be required to travel to other CH facilities for staff meetings/staff training