Under general supervision, the credentialing specialist is responsible for assuring the proper credentialing and privileging of physicians and mid-level providers. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners. This position is also responsible for meeting daily/weekly production goals and maintaining high level of confidentiality for provider information.
Responsibilities
· Guide provider through credentialing and re-credentialing process and ensure the completion of required documentation for IndieMD TX
· Works with provider to prepare and submit Medicare & Medicaid applications to enrollment office.
· Prepare all credentialing applications, develop, and provided documentation that are not supplied by the provider, address any additional information or corrections requested.
· Verify and track the proper credentialing and re-credentialing of Physicians and mid-level providers within IndieMD TX.
· Receive credentialing application and enter data into credentialing system
· Work with Provider to maintain and ensure compliance for all licensures and appointments with state and governmental agencies and certifications for each provider, generate monthly report of expiring credentials.
· Ensure ongoing monitoring of performance between credentialing cycles, generate performance review documentation, share with department for completion, and notify external entities when a provider has been suspended, if necessary.
· Notify providers and departments of credentialing status and result, email notice to department and provider, ensure credentialing system is updated with final credentialing result.
· Track and ensure the completion of required continuing medical education courses/workshops; provide documentation to outside entities according to requirements.
· Perform all other duties as assigned.
Requirements
· Three (3) years administrative experience, preferably in the hospital or clinical field, is required.
· Ability to effectively serve the customer’s need strong attention to detail and ensuring accuracy.
· Ability to work independently under limited supervision
· Strong multitasking and organizational skills
· Exhibits accuracy and thoroughness; monitors own work for quality
· Strong organizational and time management skills
· Proficiency in relevant software such as HSTREAM, PECOS, Availity, Cigna, UHC, and other payer portals.
· Strong verbal, written, and interpersonal communication skills
Benefits
Why this job is AWESOME:
Join us and you will see…we don’t do things like everyone else. We are the newest and fastest growing in popularity for mobile healthcare servicing long-term care facilities. It’s no secret how we're accomplishing this… it’s our incredible team members and the winning culture we’re building!
If you are looking for an amazing practice to work for, grow, learn, and have a blast - this is it.
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