Medical Staff Credentialing Specialist processes credentialing and recredentialing applications for health care providers. Mails, reviews, and verifies credentialing applications. Being a Medical Staff Credentialing Specialist loads and maintains provider information in an online credentialing database system. Tracks license and certification expirations for medical staff to ensure timely renewals. Additionally, Medical Staff Credentialing Specialist handles and resolves inquiries regarding credentialing information, process, or status. Requires a high school diploma. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to a supervisor. The Medical Staff Credentialing Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Medical Staff Credentialing Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
SUMMARY:
Responsible for all aspects of the credentialing, recredentialing and Privileging processes for all medical providers and therapists who provide patient care at NAMHS or contracted sites. Maintain up-to-date data for each provider in a credentialing database and online systems; ensure timely renewal of licenses & certifications.
DUTIES AND RESPONSIBILITIES:
· Complies and maintains current and accurate data for all providers.
· Completes provider credentialing and recredentialing applications, monitors applications closely.
· Maintains copies of current state licenses, DEA Certificates, malpractice coverage and any other required credentialing documentation for all providers.
· Maintains knowledge of current health plan and contract requirements for credentialing providers.
· Set up and maintain provider information in credentialing database.
· Track license and Certification expiration dates for all providers to ensure timely renewals.
· Updating Practice information with Insurances as needed.
· Process applications for Privileges at contracted sites.
· Regularly Audits health plan directories for current and accurate provider and practice information.
· Maintains confidentiality of provider information.
QUALIFICATIONS:
· Knowledge and understanding of the credentialing process (not required but, preferred).
· Ability to organize and prioritize work.
· Ability to manage multiple priorities.
· Excellent verbal and written communication skills including letters, memos and emails.
· Excellent attention to detail.
· Ability to research and analyze data.
· Ability to work independently with minimal supervision.
· Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization.
· Proficient use of Microsoft Office applications (Word, Excel, Outlook) and internet resources.
Job Type: Full-time
Pay: $18.00 - $23.00 per hour
Benefits:
Schedule:
Experience:
Work Location: In person
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