Credentialing Specialist

SOUTH TEXAS RENAL CARE GROUP

215 N San Saba Ste 206, San Antonio TX 78207

Credentialing Specialist

Summary

Evaluates, analyzes, and coordinates all aspects of the credentialing and recredentialing processes for practitioners practicing within STRCG, and VASC clinical entities. Will also be responsible for ancillary credentialing for TVC entity.

Duties and Responsibilities

1. Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and regulations, guidelines, policies, and standards.
2. Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and STRCG/VASC/TVC criteria.
3. Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and resolves problems and credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
4. Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
5. Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
6. Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards.
7. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
8. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

• High school diploma or GED; at least two years of experience directly related to the duties and responsibilities specified.

Knowledge, Skills and Abilities Required

• Ability to communicate effectively both orally and in writing.
• Customer service skills.
• Ability to respond to emails timely and effectively.
• Information research skills.
• Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
• Ability to make decisions and judgments.
• Demonstrated advanced working knowledge of Microsoft Word and Excel.
• Advanced skills in computerized spreadsheeting and database manage