Credentialing Specialist

Job Title

Credentialing Specialist

Department

Revenue Cycle

Reports to

Chief Revenue Cycle Officer

Status

Full Time/Non-Exempt 

Credentialing Specialist Position Summary

The Credentialing Specialist is responsible for performing or coordinating all assigned activities associated with credentialing or re-credentialing providers and facilities. This includes maintaining databases of information and documents as well as analyzing payor enrollment-related data. This position works collaboratively with other areas of revenue cycle, operations, and compliance to meet the needs of the organization.  

Credentialing Specialist Detailed Responsibilities

• Initiates and coordinates the acquisition and receipt of all credentialing documentation from new and existing providers; provides follow-up and problem resolution as necessary.
• Ensures initial and re-credentialing applications are submitted for all contracted health plans and government entities.
• Resolves escalated contract and credentialing issues with health plans and other organizations.
• Works collaboratively with physician practice group to maintain updated physician information.
• Manage and perform day-to-day activities related to provider enrollment and facility credentialing.
• Update health plans with practice changes, i.e., new site locations, equipment, physician activities, etc.
• Maintains relationships with vendors, payors, and other third parties in order to enhance strategic relationships.
• Monitor payer files for accurate and timely claims processing.
• Foster teamwork and unity among departments. 
• Accomplish organizational goals by accepting ownership for accomplishing new and different requests and exploring opportunities to add value to the organization. 
• Establish and maintain controls and feedback systems to monitor departmental objectives.
• Participates in on-going training for compliance, payor information, and insurance benefits to augment knowledge of procedures, regulations, and products.
• The demonstration of ethical and professional conduct, including the ability to maintain confidentiality.
• Maintains HIPAA compliance.
• Performs other job-related duties as assigned or requested.

Credentialing Specialist Specific Job Knowledge, Skill, and Ability

• Proficient in MS Office applications.
• Strong communication and interpersonal skills.
• Proven analytical, investigative and creative problem-solving ability.
• Ability to organize and coordinate work efficiently and set priorities.
• Knowledgeable about operational characteristics and procedural requirements of third-party payers. 
• Proven analytical, investigative, and creative problem-solving skill set.
• Ability to communicate calmly, compassionately, and professionally with all external and internal contacts. 
• Demonstrates “World Class Customer Service”.
• Ability to work in a goal-driven, fast-paced environment with a high aptitude for learning. 
• Ability to work with minimal supervision.
• Dependable and flexible.
• The demonstration of ethical and professional conduct, including the ability to maintain confidentiality (HIPAA). 

 Among the many benefits of a career with Southwest Medical Imaging, are the following:

• Medical, Dental & Vision Coverage
• Health Savings Accounts (HSA-available if enrolled in a high-deductible plan)
• Flexible Spending Accounts (FSA)
• Dependent Care Reimbursement Accounts (DCRA)
• Employee Assistance Program (EAP available if enrolled in Health plan)
• 401(k) retirement plan
• Paid Time Off (PTO)
• Company Paid Basic Life & AD&D Insurance
• Voluntary Life Insurance
• Voluntary Short Disability 
• Company Paid Long-Term Disability
• Pet Discount Program
• 6 paid Company Holidays 
• Floating Holiday, Jury Duty & Bereavement Leave
• Tuition Reimbursement
• Competitive Salary
• Leadership Mentoring Opportunities

Qualifications

• High School Diploma or Equivalent required. 
• Understanding of healthcare industry required.
• Prior credentialing/Payor enrollment experience preferred.

Physical Requirements

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms, and talk and hear. The employee is frequently required to sit. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.