Credentialing Specialist

Description

The Credentialing Specialist, under the direction of the Supervisor of Credentialing/Sr. Director of RCM is responsible for overseeing and verifying credentials of local medical professionals. The credentialing specialist will be required to keep up to date with the latest state, local, and national policies and credentials. Must track medical professionals to ensure proper training, certifications, and experience. Job responsibilities will include managing databases with information pertinent to this position as well as verifying the liability and eligibility of doctors in the facility. Must be competent with the latest procedures and medical policies in order to ensure facilities and professionals are properly credentialed and following accurate procedures.

MINIMUM QUALIFICATIONS: 

Education and Experience:

· High school diploma or GED.

· 1 or more years of credentialing experience with medical staff is preferred.

· General computer skills with working knowledge of word processing, spreadsheet, and email applications.

· Detail-oriented with good analytical and organizational skills.

· Good interpersonal skills with the ability to work cohesively within a team environment.

· Excellent oral and written communication skills to effectively communicate with customers and all levels of management.

JOB KNOWLEDGE

• Communication skills to converse clearly over the telephone and in person.
• Organization and time management to manage a variety of tasks effectively.
• Attention  to detail to correctly identify credentialing issues and communicate difficulties with managers.
• Technological  skills, such as using word processing and spreadsheet programs to track  data
• Ability to  gather and interpret data.
• Ability to work independently in a fast paced environment.

ESSENTIAL DUTIES:

• Process initial credentialing and re-credentialing applications
• Screen practitioners’  applications and supporting documentation to ascertain their eligibility
• Present applications to the facility’s Credentialing Committee
• Assist customers with credentialing inquiries
• Reliably back up data
• Capture primary source documentation in computer databases
• Ensure compliance with  applicable laws, regulations, procedures, and policies
• Assist with other clerical tasks as needed
• May refer to senior staff for assistance with higher-level problems that may arise.
• Escalates issues to the supervisor for resolution, as deemed necessary.
• Assist with various projects as assigned by the direct supervisor.
• Meets and exceeds short and long term goals as established for the department.
• Performs duties and job functions in accordance with the policies and procedures established for the department.
• Reports to work, meetings and professional obligations on time.
• Participates in administrative staff meetings and attends other meetings and seminars.
• Assists in evaluation of reports, decisions, and results of department in relation to established goals.
• Recommends new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed.
• Takes ownership of special projects, researches data and follows through with detailed action plans.
• Actively participates in problem identification and resolution and coordinates resolutions between appropriate parties.
• Performs other related duties as required and assigned.
•  Adheres to Corporate, Department and HR policies and procedures.

Requirements

PHYSICAL REQUIREMENTS:

• Employee  is required to have visual and auditory acuity necessary for communications with other employees and/or customers to meet business needs of NHVC.  
• Employee must be able to see written documentation and be able to speak and hear for communication with employees/customers.  
• Ability to  use a wide array of office equipment including, but not limited to a PC, copier, fax, multi-line telephone, etc.  
• Employee is exposed to general indoor working conditions and may on occasion  require light lifting or no greater than 20 pounds and some offsite travel.
• This is an on-site position