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 sets up and maintains provider information in an online credentialing database system. Tracks license and certification expirations for all providers to ensure timely renewals. Additionally, Medical Staff Credentialing Specialist may require an associate degree or equivalent. May require certification as a Certified Provider Credentialing Specialist (CPCS). Typically reports to a supervisor or manager. 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)
The Credentialing Specialist is responsible for assisting in all aspects of the licensing and credentialing of the Company. The Specialist will process applications on behalf of the Company in order to ensure compliance and completeness of licenses and agreements with Medicare, state Medicaid agencies, federal, state and local licensing agencies and private health insurance companies.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Include the following as well as other duties and responsibilities, which may be assigned.
QUALIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and must possess the ability to: interact professionally and ethically with team members, all levels of management, government agencies and commercial payer personal; handle multiple tasks simultaneously; provide clear, concise oral and written directives/communications; quickly assess situations and respond appropriately; handle special requests in a sensitive, professional manner. Strong attention to detail and follow through is required. Meticulous organization and filing skills. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
QUALIFICATION REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION AND/OR EXPERIENCE:
TRAINING:
Our industry is a highly regulated industry, and because of that and our commitment to providing the best in class products, services, and support, we require ALL employees to complete the following training programs prior to the marketing and promotion of our products, services, and support systems:
CONTINUING EDUCATION:
To continue to be best in class within our industry, we require all employees to participate in ongoing education to maintain / increase their competency or in the event the team member changes responsibility within the company.
Notice:
Employment with the Company is “at will.” This means a team member or the Company may end a team member’s employment at any time with or without reason. None of the Company’s policies, procedures, or practices, including those set forth on the Company Website and/or Intranet, are to be viewed as creating any promises or contractual rights. They are guidelines that the Company may, at its discretion, change at any time without prior notice to any team member. The information contained in this policy replaces all previous handbooks and other statements of Company policies, rules, and procedures.
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