Medical Staff Credentialing Specialist, Sr. jobs in Charlotte, NC

Description

Metrolina Nephrology Associates is the region’s most recognized and experienced nephrology group. The practice has been on the forefront of the treatment and management of kidney disease for more than 40 years. Our extensive network of providers and offices allow our practice to deliver care in an atmosphere that is personal, patient centered, and compassionate.

It is our mission to provide the most comprehensive nephrology services available with a personal commitment to enhance our patients’ quality of life through professional activity and dedication.

To attract the best and the brightest, Metrolina has competitive wages and benefits and a generous paid time off package beginning in your first year of employment: 4 weeks (accrued) paid time off PLUS 7 additional paid holidays! We also have a generous 401k plan with two entry dates after 90 days of employment. Voted by employees as a Best Places to Work in Healthcare by Modern Healthcare 3 years running.

A non-exempt office position responsible for the credentialing of all providers (Physicians and Advanced Practitioners) within practice, and relevant administrative support to providers (Physicians and AP’s)

Includes, but not limited to:

• Coordinate initial provider credentialing for all NEW providers per the company Credentialing Policy for all entities needed/requested per the provider’s contract and schedule.
• Initiate new provider setup including but not limited to: credentialing file, compile documents, coordinate/schedule headshot, equipment needs, acquire web profile “area of interests”
• Maintain provider licensure and renewals as needed.
• Coordinate necessary training requirements for providers to receive and maintain privileges at facilities.
• Process all re-credentialing applications of hospital systems and dialysis companies.
• Track down approval letters/confirmation of privilege status at all outside facilities. Follow up as needed.
• Assist with the collection, completion and distribution of all peer reference requests from hospital systems and dialysis companies.
• Maintain individual credentialing file for all providers to include all necessary and up to date working documents.
• Keep current health records for all providers in credentialing file and distribute as requested/needed.
• Maintain CAQH database for providers up to date information, documents and attestations.
• Handle all insurance attestation/document requests. Fulfill insurance carrier requests for demographic/provider database updates.
• Manage calls/emails from outside facilities for provider document requests and schedules.
• Report delinquent hospital medical record notifications to relevant provider and Director of Quality & Compliance.
• Ensure all relevant licensure is posted at respective office location.

Requirements

• This position requires professional and timely communication with providers and outside partners with whom we provide services to.
• Must be able to process many applications concurrently and maintain forward momentum with them all. This includes hospitals, dialysis units and also insurance carriers such as BCBS and Medicare etc.
• Highly organized, proficient in Microsoft Office, Outlook and credentialing software. We are currently transitioning to a new program.
• Experience: Minimum three years of experience in managed care and hospital credentialing. Minimum three years in the health care industry.
• Education: Associates degree in healthcare or any combination of education, training and experience that demonstrates the ability to perform the duties of the position.