Credentialing Specialist

SUMMARY:

The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by SBCHC, commercial payers, Medicare and Medicaid.

QUALIFICATIONS:

• High school graduate or equivalent
• 2 years credentialing experience preferred
• Knowledge of provider credentialing and its direct impact on the practice's revenue cycle
• Excellent computer skills including Excel, Word, and Internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Good oral and written communication skills
• Ability to deal professionally, courteously and efficiently with the public and all levels of the organization
• Ability to handle multiple projects simultaneously
• Ability to operate computer, copier, fax
• Proficient in practice management system and Microsoft Office software applications
• Knowledge of HIPAA guidelines and requirements

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Maintain individual provider files to include current information needed to complete the required SBCHC and insurance credentialing applications.
• Maintain internal provider list to ensure all information is accurate and logins are available.
• Update and maintain accurate profiles for each provider's CAQH, PECOS, NPPES, CMS
• Complete revalidation requests in a timely manner.
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid and new facilities.
• Complete re-credentialing applications for all payers.
• Work closely with the billing manager and billing staff to identify and resolve any denials issues related to provider credentialing.
• Work special projects assigned by billing manager.
• Other duties as assigned
• Cross trained to provide billing department coverage in any task needed to meet end of the month deadlines.
• Responsible for staying current with the rules and updates or changes in state and federal regulations.
• Continually search for ways to improve the accounts receivable process, striving for efficiency in daily operations.
• All Health Center staff members have emergency and disaster response responsibilities. Participates in all safety programs which may include assignment to an emergency response team.