Credentialing Specialist

Posting Title

Overview

In a way, that best supports our values, the individual is responsible for the daily activities of credentialing and payor enrollment processes for Fast Pace. The Credentialing Specialist will play an important role in leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. The Credentialing Specialist facilitates all aspects of Fast Pace’s credentialing, including initial provider enrollments, reassignments, and maintenance updates, as well as the credentialing of providers for health plan clients. The Credentialing Specialist ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing and payor enrollment.

Responsibilities

Essential Functions:

• Obtains, verifies, and analyzes all required information pertinent to internal and external Credentialing.
• Organizes the credentialing process to meet required timelines.
• Educates and supports clinicians in completing the credentialing process.
• Interfaces with health plan contacts to understand and support the credentialing application and completion process.
• Supports company processes to assure licensure and certification are maintained.
• Supports company processes for state regulatory requirements for physicians, nurse practitioners, physician assistants and other providers.
• Participates with the team to implement and adhere to policies, procedures, and systems to ensure timely data entry and enrollments in current Practice Management system.
• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals.
• Collaborates with Manager of Credentialing to create new processes and procedures as needed to improve overall claims escalation process.
• Performs a variety of administrative duties including, but not limited to: answering phones, faxing and filing
• Responsible for learning the aspects of compliance in the company by completing all mandatory compliance training.
• The ability to maintain friendly, cordial relations with fellow coworkers.
• The ability to build and maintain confidence and credibility with fellow coworkers.
• The ability to maintain friendly, cordial relations with all clients and employees; maintain a positive work atmosphere by acting and communicating in a manner that results in a positive work relationship with customers, co-workers and managers.
• The ability to perform the physical, use of senses, cognitive, and environmental functions of the position, as specified on the physical demands.
• Ability to comply with Company standards of operations.
• Ability to adhere to the Core Values of the Company, of teamwork, communication, empowerment, quality of care, and friendliness.
• The ability to promote and maintain a respectful culture of employee, employer and business confidentiality.
• Perform other duties as assigned by management.

Experience Requirements and Preferences:

Basic Requirements: 

            Education:                 High School Diploma or its equivalent

                AND

Experience:   Previous experience in credentialing of physicians, nurse practitioners, or physician

assistants (minimum of 2 years preferred)

• Associate’s or Bachelor’s Degree in healthcare or business administration (preferred but not required)
• Experience in use of the Council for Affordable Quality Healthcare (CAQH), Universal Provider Data source (UPD) for credentialing support.
• Ability to use computer systems including but not limited to Word, Excel, and

credentialing software

• Excellent organizational skills
• Strong customer service approach
• Attention to detail
• Ability to work independently

Current License or Certification:

• Not required at time of hire, but Fast Pace will assist with CPCS or CPMSM certification.

Education Requirements:

Compliance

Fast Pace Health is committed to the principle of equal employment and creating an inclusive environment for the benefit of our employees, our patients, and our communities. We are an equal opportunity employer and welcome job applications from qualified individuals without regard to race, creed, color, ancestry, religion, sex, sexual orientation, gender identity, pregnancy, national origin, age, disability, veteran status, marital status, parental status, genetic information or any other legally protected characteristics or conduct. Please refer to the links below for information regarding your rights under certain federal laws: https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/fmlaen.pdfhttps://www.dol.gov/whd/regs/compliance/posters/eppac.pdfMississippi Residents Only:In Mississippi, Fast Pace requires pre-employment/drug/alcohol testing as a condition of employment. The law requires that Fast Pace notify applicants, in writing, upon application and prior to the collection of the specimen for drug and alcohol test, that they may be tested for “the presence of drugs [or alcohol] in their metabolites.” Miss. Code. Ann. § 71-7-3(5).

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