Credentialing Specialist

Description

The Credentialing Specialist is responsible for evaluating, analyzing, and managing all aspects of the credentialing and recredentialing processes. This role supports healthcare organizations by ensuring the timely onboarding of providers. The specialist processes applications to meet targeted start dates and renewal deadlines, monitors license renewal activities, and maintains systems to track expiring credentials and certifications

Requirements

Essential Position Responsibilities:

• Responsible for adherence of credentialing policies and processes, assisting Director with reviewing on an annual basis to meet the National Committee for Quality Assurance (NCQA) standards
• Set up Council for Affordable Healthcare (CAQH) accounts for Southeast Medical Group (North Atlanta Primary Care, P.C.) during onboarding process, uploading supporting credentialing documents, and coordinating re-attestations 
• Facilitate and track application paperwork as part of onboarding process
• Identify, analyze and resolve information discrepancies that could adversely impact ability to credential and enroll providers, conveys problems to Director for sound decision making in accordance with credentialing policies 
• Primary source verifies documents using NCQA approved sources to ensure compliance with state-specific regulatory credentialing standards as well as individual payor policies
• Maintain complete and accurate credentialing files, assisting Director in presenting to Medical Director and/or committee for approval
• Assist Director with preparing for delegated credentialing audits and inspection by third party payors
• Maintain integrity of database, monitoring compliance and expirable data
• Meet targeted credentialing deadlines and start dates
• Participate in job-related training, tracking CEUs if required to maintain certification

Required Qualifications, Knowledge & Ability:

• Always observes corporate and client confidentiality
• Able to prioritize and manage multiple tasks, demonstrating problem solving skills and strong attention to detail
• Demonstrates effective communication skills both verbally and in writing
• Intermediate computer proficiency with software programs such as Microsoft Office is required
• Customer service orientated, actively looking for ways to help others
• Strong interpersonal skills and focused on meeting standards of customer satisfaction 
• Handle multiple projects simultaneously and manages time wisely with ability to prioritize and organize tasks
• Independent judgement and the ability to exercise decision making without supervision

Education & Experience Required:

• Bachelor’s degree or equivalent business-related continuing education required
• 3+ years of experience in medical staff office or credentialing field required
• Certified Provider Credentialing Specialist (CPCS) preferred

Key physical and mental requirements:

• Ability to lift up to 50 pounds
• Ability to push or pull heavy objects using up to 50 pounds of force
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

FLSA Classification: Non-exempt

Southeast Primary Care Partners is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

12/2024