Credentialing Administrative Specialist
Under general supervision, provide support to the Credentialing Department as requested by Credentialing Department Director and/or Manager. Responsibilities include assisting in meeting regulatory requirements and performing credentialing and administrative duties needed for the Credentialing Department to run efficiently and smoothly.
What You Will Do:
- Provide support to the Credentialing Department as requested by Credentialing Department Director.
- Review monthly or more often as appropriate, disciplinary action reports issued by State licensure bodies and Office of Inspector General Medicaid and Medicare Sanctions report; identifying any participating providers appearing in the databases and invoking the appropriate process as defined in policy and procedure.
- Run monthly reports from the credentialing database to identify documents soon to expire such as current license, DEA, Professional Liability Insurance certificates and Board Certifications. Follow -up with providers to obtain receipt of requested documents and update credentialing database with current information. Forward updated documents to hospitals and health plans.
- Organize incoming documents, saving them electronically and making them available for staff use by connecting them to the credentialing database.
- Maintain credentialing database with updates related to provider address and demographic changes.
- Obtain National Provider Identification numbers and DMG malpractice certificates as requested.
- Process incoming mail daily, assuring that all mail is forwarded to providers appropriately and timely.
- Order department supplies, keeping inventory level within the department.
- Forward termination requests to all health plans in a timely manner.
- Breakdown and organize credentials files of terminated providers for tracking and forwarding to outside retention center.
- Assist credentialing staff by following established guidelines for obtaining checks from the accounting department, tracking request until check received.
- Assist providers with required paperwork for renewal of state license and DEA registration.
- Maintain orderly credentialing file for each provider.
- Enter contact and action notes into credentialing database to maintain accurate record of progress with processes.
- Employ public relations skills in a wide variety of contacts with internal and external sources for purposes of soliciting information essential to health plan enrollment / credentialing.
- Establish and maintain a professional working relationship with providers, their outside office staff, and DMG staff.
- Become proficient in the use of Visual Cactus (credentialing database) with input as well as reporting functions.
- Become proficient in the use of Microsoft Word and Excel for Visual Cactus; NPI (National Practitioner Identification on-line access); Certifacts (American Board of Medical Specialties on-line access); State licensing agencies on-line access and Internet Explorer for other internet access.
- Maintain compliance with all company policies and procedures.
- Other duties as assigned.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be interpreted an exhaustive list of all responsibilities, and duties required of employees assigned to this job.
What You Will Bring to the Role:
- Understanding of the need of the credentialing process in the health care environment and the impact on quality patient care.
- Familiarity with the National Association for Quality Assurance Standards and Guidelines for MCO accreditation.
- Problem solving and decision making.
- Understanding/compliance of HIPAA laws and regulations.
- Computer proficiency (MS Office - Word, Excel and Outlook).
- Highly organized with excellent attention to detail and a demonstrated high regard for clerical accuracy.
- Excellent verbal and handwriting skills.
- Ability to read, extract and interpret information comparing such to established departmental policies.
- Excellent customer services and public relations skills required.
- Must be flexible and willing to work extra hours during peak workloads and deadlines.
- Ability to work as a team player with willingness to assist other team members as needed.
- Must be able to work under pressure and meet deadlines.
- Self-motivated with the ability to work independently and to carry out assignments to completion within parameters of instructions given, established time frames, prescribed routines, and standard accepted practices.
- Ability to operate standard office machines and equipment, including telephones, computers, copy machines, fax machines, calculators, scanners and shredders.
- Ability to type 35 wpm.
- Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or federal, state and local standards.
- Ability to maintain regular, punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards.
Education or Equivalency
- High school diploma or equivalent
- One year of credentialing or medical administrative experience in a hospital, managed care, or physician office practice setting is preferred as well as experience in an office setting or training in basic office skills including personal computer use with proficiency in Microsoft Word, Excel and Outlook as well as Web experience is required.
FTE Status/Scheduled Hours of Work:
- This is a full-time position, Monday through Friday. Occasional evening and weekend work may be required and/or hours may be shortened as job duties demand.
Environmental Working Conditions
- Normal office environment.
- The noise level of the work environment is usually low to moderate.
- Pay Type Hourly
- Required Education High School
- Job Start Date Friday, October 1, 2021