JOB TITLE: Credentialing Specialist
SUMMARY OF DUTIES: Directly responsible for all provider credentialing to ensure healthcare professionals and services meet all established federal and state standards as well as hospital and other organizational requirements.
SUPERVISED BY: Reports directly to Director of Revenue Cycle Management
- Compiles and maintains current and accurate data for all providers including the following:
- Hospitals – New physician, PA/NP
- Insurance Quarterly Updates – CAQH, United Healthcare, Availity, Humana
- American Board of Urology
- Alabama Board of Medical Examiners
- Maintain current CVs, medical licenses, driver’s licenses, DEA licenses, CME documentation and requirements.
- Update liability coverage for providers as required by carriers and facilities
- Completes provider credentialing/recredentialing applications; monitors applications and follows-up as needed.
- Maintains corporate provider files.
- Maintains knowledge of current health plan and agency requirements for credentialing providers.
- Maintains provider information in online credentialing databases and systems.
- Tracks license and certification expirations for all providers to ensure timely renewals.
- Audits health plans for current and accurate provider information.
- Transcribes dictation from doctors and other providers (letters, additions to clinic notes, referral responses).
- Input nurse notes when needed.
- Maintain other lists and spreadsheets as needed for corporate office.
- Prior credentialing experience
- Proficient in MS Word, Excel, Outlook
- Experience using transcription programs preferred (SpeechExec Pro, FaxFinder Client)
- Type 70 WPM or more
- Ability to multitask
- Ability to work independently
- Detail oriented
- Ability to maintain the highest level of confidentiality
- Ability to focus and work proactively to meet deadlines
- Pleasant and professional personality
- Professional communication skills
- File maintenance
ENVIRONMENTAL / WORKING CONDITIONS: Work is performed in an office environment requiring long periods of sitting and computer usage. Involves frequent personal communication and telephone contact with internal and external contacts. Work may be stressful at times. Interaction with others is constant and interruptive.
PHYSICAL DEMANDS: Work may require hand dexterity for telephone and office machine operation and sitting for extended periods of time. Lifting up to 25 pounds.
EDUCATION: High school graduate with 5 years medical credentialing experience preferred.