Credentialing Specialist

Under the supervision of the Credentialing Supervisor, the Credentialing Specialist will be responsible for the effective, accurate and timely manage care credentialing for all clinicians (i.e., licensed independent practitioners and allied health practitioners) in accordance with federal, state and department procedures. Responsible generating accurate reports including the credentialing status and data related to clinician productivity. Maintains up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

RESPONSIBILITIES AND DUTIES

· Provides direct support to the Credentialing Supervisor to administer regulatory compliance and quality assurance to the Credentialing Department and the organization.

· Maintains current and accurate credentialing/privileging files for all licensed independent practitioners.

· Prepares manage care credentialing and re-credentialing applications for completeness and accuracy for LIPs; ensuring all required documents are included for the application process and maintaining an opportune monitoring and follow-up process for all credentialing and re-credentialing applications.

· Notifies manage care plans of all terminations and demographic changes for all LIPs.

· Audit managed care plans on a monthly basis to ensure that all LIPs are accurately enrolled with all appropriate practice locations.

· Complies and maintains accurate monthly reports/rosters of all enrolled/credentialed practitioners; confirming all providers are appropriately enrolled with the correct managed care plans.

· Updates and maintains the credentialing database and the EHR (Electronic Health Record) database.

· Maintains present-day requirements for provider enrollment (including manage care representative contact information), credentialing and privileging; in compliance with the policy & procedures of the organization, managed care plans.

· Updates clinical service areas, site coordinators, practice managers and site leads on a consistent basis as to the credentialing status of all LIPs, by complying a reliable report (MOCHA).

· Perform other related functions as assigned.

QUALIFICATIONS

· Associates Degree or equivalent experience

· Computer literacy; WordPerfect, Excel, PowerPoint, Windows 95

· Team player

· Excellent interpersonal skills

· Detail-oriented, organized, reliable, flexible and responsible

· Ability to handle and prioritize multiple tasks concurrently

· Able to meet deadlines

· Knowledge of health care procedures

· Ability to prepare reports

· Strong customer service skills

· Strong written and verbal communication skills