Credentialing Specialist

Description

The Credentialing Specialist is responsible for processing information to ensure that all healthcare professionals are credentialed and are participating in company contracted managed care organizations (MCOs). The Credentialing Specialist primary job is to evaluate, analyze, and coordinate all aspects of the credentialing and re-credentialing processes for practitioners practicing within the CAIPA Network. Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers.

Growth

Responsibilities includes but are not limited to the following:

• Work collaboratively with offices, marketing team and MCOs to drive membership growth and retention
• Monitor and identify trends on membership decline and escalates to leadership as appropriate
• Meets organization membership objectives by recruiting, engaging, and communicating with the target market
• Communicates effectively with all necessary contacts, internal and external.
• Demonstrates superior time management skills and meets target deadlines
  
  

Service

• Serve as single-point-of-contact to the physician network and is accountable and responsive to physician needs
• Build collaborative relationships with network physicians and their office staff, and MCOs individual representatives
• Coordinate credentialing/enrollment of new and established health care providers
• Data collection, review, and organization
• Maintains and updates database with essential data elements.
• Manage a scheduled cadence for touch points and ensures that agreed upon agenda is followed and action items are documented and tracked
• Responds promptly to departmental related questions, received via phone or email.
• Documents all tasks, phone calls, emails and other forms of communication in the database promptly.
• Prepares appropriate information/report for credentialing and enrollment in a timely and complete manner.
• Obtains results upon completion of tasks and continues accordingly to standard operating procedures.
• Escalates issues to applicable members of the management staff and/or colleagues as necessary.
• Compliance to workflows, policies and procedures.
  
  

Visibility

• Attend external office staff meetings and community/town hall meetings, as required, and completes any action items that may arise from those meetings
• Maintain awareness of providers interested in further aligning with organization on new business opportunities, and on shifting market/competitive dynamics that would impact the Network
• Expected to travel to physician offices or other facilities as needed
• Completes other tasks or projects as assigned.
  
  

Requirements

• High school diploma or GED; at least five years of experience directly related to the duties and responsibilities specified. Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year-for-year basis. )
• Excellent multi-tasking, prioritizing, and time management skills.
• Knowledge and experience with Google applications, Adobe, and Microsoft Office products.
• Proficient in creating and manipulating spreadsheets utilizing intermediate formulas and functions.
• Critical thinking skills to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Strong communication and interpersonal skills to effectively present information and respond to questions from representatives, providers, and the general public.
• Good aptitude for self-sufficiency with the ability to work both independently or with others.
  
  

Benefits

• Competitive Medical, Dental and Vision Benefits
• 401k Retirement Plan
• 13 Paid Holidays
• PTO Rollover
  
  

Salary: 45k - 58k