Credentialing Specialist

Job Description

Job Description

Hybrid Position!

Benefits :

• Competitive Health & Welfare Benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

Minimum Qualifications :

• Minimum of 2 years of credentialing experience.
• High school diploma/GED or equivalent working knowledge preferred.
• Must be able to communicate effectively with physicians, providers, licensing agencies, insurance payors, and the public
• Must be capable of establishing good working relationships with both internal and external customers.
• Some knowledge of insurance billing and hospital credentialing is a plus.

Essential Functions

• Reviews and completes hospital and payor applications for all health care providers.
• Completes verification forms/letters for outside facilities.
• Maintain billing insurance grid, provider insurance grid, and each physician’s spreadsheet up to date on current insurance changes.
• Track and maintain physician licensure(s), certification, and CME credits.
• Maintain practitioner credentialing files.
• Maintain practitioner electronic file by keeping all applications/licensure current.
• Maintains all renewal applications for both hospitals/insurances.
• Has knowledge of Employee Handbook content along with established policies and procedures.
• Relies on instructions and pre-established guidelines to perform the functions of the job.
• Assists the Credentialing Supervisor in their job responsibilities/duties when necessary.