Credentialing Specialist
Credentialing Specialist
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Job Description
Job Details
Description
Primary Objective
This position is responsible for verifying professional credentials and processing the information in compliance with all regulatory standards by performing duties within the scope of the policy and procedures defined by Charlotte Eye Ear Nose and Throat Associates.
Essential Functions
- Maintain individual provider files to include uptodate information needed to complete the required governmental and commercial payer credentialing applications
- Maintain accurate provider profiles on CAQH NPPES and CMS databases
- Complete credentialing applications to add providers to commercial payers CMS and Medicaid
- Complete recredentialing requests issued by government and commercial payers
- Verify and maintain provider hospital privileges within CredentialStream
- Ensures all individual provider locations within the practitioner database match the CEENTA location reports
- Work closely with the Business Office to identify and resolve any denials or authorization issues related to credentialing
- Maintain the provider flu and PPD grids and forward to appropriate staff
- Update and/or provide verification of all payer directories via electronic submission email (spreadsheets) and/or phone
- Provides profile updates/verifications for active and termed CEENTA providers to various facilities
- Maintain and submit monthly credentialing allocation reports
- Other responsibilities may be assigned by the Credentialing Manager
- Ability to meet the physical and mental demands of the position
- The ability to work onsite. Remote work eligible after probationary period
- Predictable reliable and prompt attendance
Skills and Abilities
- Extremely high level of attention to detail
- Ability to follow procedures and processes in accordance with CEENTA standards and CMS guidelines
- Proficient in Microsoft applications including Excel Word and Outlook / Office365 required
- Maintain proficiency with office equipment utilized to perform duties which includes dual monitors printers and OnBase faxing program
- The ability to multitask and prioritize work is required
Core Competencies
- High level of attention to detail
- Building trust
- Communication
- Followup
- Professionalism
Clinical Competencies
N/A
Training Period
3090 days
Accountability
Our mission is to be the premier eye ear nose and throat group providing comprehensive quality and ethical healthcare to all in the Carolinas; to provide a favorable environment for the delivery of healthcare; and to provide for the wellbeing of the physicians and the employees of Charlotte Eye Ear Nose & Throat Associates P.A.
The selected candidate must be reliable and dependable.
Qualifications
Education
High School diploma or general education degree (GED)
Experience
- 2 years medical staff credentialing experience required
- 2 years experience in a medical practice business office role preferred
- Experience with credentialing software packages NPPES PECOS and CAQH enrollment
Certificates Licenses Registrations
NAMSS CPSC Certification preferred not required
Work Environment
The work environment characteristics described are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Supervisory Responsibilities
This position has no supervisory responsibilities
Position Type and Expected Hours of Work
Fulltime. Standard hours of operation (and working hours): 8am5pm MondayFriday. Additional evening/weekend hours may be required to complete system updates
Upon successful completion of a probationary period and in good standing employee is eligible for remote work
Physical Mental Other Requirements
The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- Requires sitting for long periods of time with repetitive movements such as typing
- Sitting at least 90 of the time
- Must be able to work independently and in a group setting
- Requires a high level of attention to detail
Other Requirements:
- Active & Current Drivers license
- Clean driving record
- Consistent and Reliable Transportation
- Polite and professional disposition
Travel
Less than 10 travel
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this job. In addition to those essential functions identified above individuals in this position are also responsible for performing other duties or tasks that may be assigned. CEENTA retains the discretion to add or change the essential job functions of this position at any time without notice.
A Typical Day in the Position
90 of the work will be performed on a computer with dual monitors. This position is responsible for answering incoming calls processing incoming correspondence and updating provider demographics into the credentialing database as well as other pertinent information. Daily interaction with providers and practice managers. This position is also responsible for data entry of credentialing and insurance information responding to credentialing inquiries and retrieving/sending faxes as part of their daily responsibilities.
Required Experience:
Unclear Seniority
Employment Type
Unclear
