Credentialing Specialist II

Description

JOB PURPOSE: A non-exempt position responsible for the accurate and timely processing of provider credentialing, enrollment, and re-credentialing for medical facilities and health plans. This role supports provider onboarding and ongoing compliance by coordinating with internal departments, practitioners, medical staff offices, and external payer entities to ensure credentialing requirements are met efficiently and in accordance with organizational policies.

JOB FUNCTIONS:

• Initiate and support the credentialing application process by requesting, receiving and analyzing the provider’s documents for submission to the facilities for approval for medical staff privileges and payer credentialing/enrollment
• Collectively works with recruitment for onboarding practitioners and medical staff office team to assure practitioner’s credentialing process is efficient and timely
• Use critical thinking to conduct follow-up with individual practitioners, internal and external entities to resolve discrepancies identified during credentialing and enrollment process that may inhibit timely onboarding
• Manage all phases of payer credentialing/enrollment, re-credentialing/re-enrollment, notification of changes including termination of group practitioners
• Complete regular follow-up with the payers to ensure credentialing and enrollment is complete and escalate communication with payer provider enrollment staff of any issues prohibiting timely credentialing/enrollment
• Keep Physician Services Manager and supporting departments informed of potential credentialing and enrollment issues
• Update and maintain provider credentialing information database and electronic data files in accordance with internal policies and procedures while also maintaining confidentiality of provider information
• Actively participate in team meetings and process improvement initiatives to continuously improve work product and efficiency
• Develop, document, and maintain accurate work instructions for the desk, ensuring all procedures and information remain current
• Promote the purpose, values and foundations of Inspire Health Medical Group at all levels of the organization and to our customers
• Perform other related duties as assigned to support Physician Services operations

Requirements

Education:

• High School Diploma or equivalent; Associate’s degree preferred

Experience:

• Minimum two (2) years of credentialing experience in a medical setting

Knowledge and Skills:

• Proficiency in Microsoft Office programs (Excel, Word and Outlook) and Adobe Acrobat Professional
• Strong attention to detail with the ability to manage multiple priorities and deadlines
• Knowledge of business communication, including grammar, spelling, and professional correspondence
• Ability to work independently and make decisions in a multi-faceted, fast-paced environment
• Ability to handle sensitive and confidential information in a professional manner.
• Verbal and written communication skills necessary to convey information effectively and professionally, with courtesy and tact.
• Exceptional customer service skills necessary to communicate and follow instructions effectively from a diverse group of physicians and staff.
• Ability to establish and maintain effective working relationships with other employees and the public.
• Ability to identify problems, recommends solutions, organize and analyze information.

Equipment Operated:

• Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment:

• Position is in a well-lit, well-ventilated office environment

Physical Requirements:

• Involves sitting approximately 80 percent of the day, walking, bending, stretching or standing the remainder. May be required to lift up to 15 pounds

Safety:

• All employees are responsible for complying with safe and healthful work practices as outlined in Inspire Health Medical Group’s Employee Safety and Injury and Illness Prevention Program and policies and procedures specific to their department needs.