Credentialing Specialist

Description

The Credentialing Coordinator will organize, maintain, and verify all aspects of the process, and maintain current files on practitioners. You will track the expiration of certifications to maintain up-to-date files and assist health plan providers and customers with phone inquiries.

Essential Functions

• Processing initial credentialing and re-credentialing applications.
• Screening practitioners' applications and supporting documentation to ascertain their eligibility.
• Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer, and other relevant sources.
• Identifying discrepancies in information and conducting follow-ups.
• Assisting medical staff with credentialing inquiries.
• Responding to health plan provider inquiries.
• Capturing primary source documentation in computer databases.
• Ensuring data is backed up.
• Ensuring compliance with applicable laws, regulations, procedures, and policies.
• Knowledge of medical credentialing and privileging procedures and standards.
• Excellent verbal and written communication skills.
• Proficient with Microsoft Office Word and Excel.

Qualifications

Qualifications

• Education: High School diploma
• Licenses/Certification: NAMSS certification or Certified provider credentials specialist
• Experience: 2+ years of credentialing experience with hospital medical staff.