Medical Staff Credentialing Specialist, Sr. processes credentialing and recredentialing applications for health care providers. Mails, reviews, and verifies credentialing applications. Being a Medical Staff Credentialing Specialist, Sr. 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, Sr. handles and resolves inquiries regarding credentialing information, process, or status. May provide guidance or expertise to less experienced specialists. Requires a high school diploma. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to a supervisor. The Medical Staff Credentialing Specialist, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Medical Staff Credentialing Specialist, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)
-Accurately complete credentialing and reappointment applications to be sent to payers and facilities on behalf of providers.
-Monitoring workloads and ensuring completion of all assigned tasks in a timely manner – communicating with management on potential issues.
-Communicate the status of all applications to management and accurately maintain tracking spreadsheets.
-Set up and maintain electronic credentialing files for each practitioner while ensuring confidentiality and accuracy is priority.
-Request needed documentation from providers such as credentialing/recredentialing documents and information; performs primary source verification of credentialing information; reviews and analyzes the documentation for completeness and accuracy; follows up with physicians on application in a professional manner.
-Prepare professional communication both written and verbal with providers, contractors, and facilities.
-Must have the ability to make decisions in a timely fashion that are sound, accurate, and supported by the reasoning and inclusion of appropriate people.
-The successful candidate must be an enthusiastic team player who can work in a fast-paced environment, multi-task, prioritize tasks and handle obstacles with a poised demeanor and positive attitude. Investigate solutions to problems and determine the best course of action.
-Must be a self-motivated individual that communicates clearly and professionally with team members, physicians, vendors, facility credentialing representatives, and team leaders.
-3-5 years’ experience facility credentialing and or MSO required.
-Ability to demonstrate excellent oral, written, interpersonal, analytical, and negotiation skills.
-Ability to use various computer programs to include but not limited to excel, adobe and outlook.
-Ability to work autonomously with minimal direction.
-High School Diploma or equivalent required (Degree preferred)