Credentialing Specialist/FULL TIME
Credentialing specialists maintain regular cooperation and compliance with all regulatory and accrediting organizations. They create and carry out various credentialing processes in relation to physicians and healthcare providers. The specialist ensures that all personnel and services adhere to credentialing guidelines, regulations, and government laws. Credentialing specialists process applications and reappointment paperwork, checking for completeness and accuracy. They collect and process significant amounts of verification and accreditation information, and constantly maintain and update accurate databases for both practitioners and facilities. These databases include pertinent education, training, experience, and licensure content. Credentialing specialists maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent. This position requires sitting for an extended period of time with occasional stretching, reaching, walking and stooping, pushing and/or pulling. The candidate must be able to type for extended periods of time. Candidates must be able to hear and speak with others both in-person and on the phone.
Education Required
• At least 2 years credentialing experience
• High School Diploma or equivalent
Qualifications
• Must be detail oriented, with strong organizational, time-management and interpersonal skills
• Demonstrate excellent reading, verbal and written communication skills, and data entry skills
• Ability to work jointly with management, supervisors, employees, clients, etc.
• Must adhere to regular and predictable attendance
Computer Skills Required
• Proficient computer skills including Microsoft Word, Excel, Outlook
• Ability to navigate the Internet with ease
• Ability to use telephone equipment, including headset or handset
Salary
based on experience
Responsibilities
NEW PHYSICIANS:
• Obtain a Universal Application and all required documents
• Verify all information on file with the insurance companies: tax Id, addresses, specialty, etc
• Verify info on NPI Registry.
• Verify all products within the insurance companies
• Submit all re-credentialing applications
• Verify the most recent 5-year period available for sanctions or limitations on licensure in state where the practitioner provides care
EXISTING PHYSICIANS
• Submit updates and corrections to insurance companies
• If physician is not participating, verify if they want to apply. If so, submit application for physician.
• Follow up on application for the status until the application has been approved
• Verify the most recent 5-year period available for sanctions or limitations on licensure in state where the practitioner provides care
PECOS
• Maintain the physicians files for revalidation or make any changes for Medicare
MEDICARE
• Opt Out -Login to NGS and verify if any physicians opted out of Medicare
• Revalidation List–Login to NGS every month and verify if any of our physicians are listed
CAQH
• Create and populate their CAQH file
• Maintain and update all our doctors' files
• Re-attest their file every 90 days
DELEGATED
• Submit updates on a monthly basis
