Credentialing Specialist
Credentialing Specialist
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Job Description
SUMMARY: The Credentialing Specialist is responsible for preparing submitting and maintain enrollment credentialing and recredentialing documentation for physicians and other health care providers.
ESSENTIAL DUTIES and/or RESPONSIBILITIES include the following:
- Responsible for Compiling and maintaining current and accurate data for all providers
- Responsible for Data entry and maintaining provider information in online credentialing databases and systems.
- Responsible for PrimeSource Verification of State licensure DEA and Board Certification
- Responsible for Completing provider initial and re-credentialing applications
- Audio applications for accuracy and completeness
- Responsible for revalidation requests issued by Government payers
- Responsible for Submitting completed credentialing applications and supporting documentation to all requested payers.
- Responsible for monitoring application progress and following up with payers as needed until confirmation of in network status has been received
- Responsible for maintaining copies of current state licenses DEA Certifications malpractice coverage and any other required documents for all providers. As well as tracking all state license DEA and board certifications expirations for all providers to ensure timely renewals
- Responsible for tracking CME and sending quarterly updates to providers
- Utilizes strong research skills to gather pertinent information regarding providers
- And all other duties assigned
KNOWLEDGE SKILLS AND ABILITIES
- Familiar with provider credentialing and recredentialing requirements
- Strong analytic computer and software skills
- Excellent interpersonal skills including excellent verbal and written communication skills
- Ability to demonstrate a high degree of trust and confidentiality
- Ability to work independently and assume assigned responsibility
- Skilled efficiency organization time management and prioritization
- Ability to be flexible and function will in a fast-paced environment
- Ability to deal with problems involving several concrete variables in standardized situations
- Ability to communicate effectively and relate to people of different cultures
- Ability to handle confidential information
QUALIFICATION REQUIREMENTS: To perform this job successfully an individual must be able to perform each duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the duties.
EDUCATION AND/OR EXPERIENCE:
- High School Diploma and minimum of (2) years related experience preferred; or at least four years related experience and training; or an equivalent combination and work experience considered.
- Working Knowledge of credentialing accreditation regulations policies and procedures
- Certified Professional Credentialing (CPCS) Certification preferred
- Payer Provider Enrollment: (1) year (preferred)
- Healthcare: 1 year (preferred)
COMPUTER SKILLS:
- Expert level Knowledge of Microsoft Office Products.
- Experience with credentialing software preferred.
PLEASE NOTE: P.L. 93-638 Indian Preference and Tribal Employment rights Ordinance. (T.E.R.O) will be practiced; however all qualified applicants will be considered.
*Please note that the job description is subject to change with or without prior notice.*
IF YOU ARE INTERESTED PLEASE SEND APPLICATIONS RESUME TO:
OMAHA TRIBE OF NEBRASKA
ATTN: HR DEPARTMENT
P.O. BOX 368
MACY NEBRASKA 68039
OR
Must pass background check physical and pre-employment drug screen.
Required Experience:
IC
Employment Type
Full-Time
