JOB STATEMENT

The Senior Credentialing Specialist coordinates credentialing, re-credentialing, privileging, and enrollment of providers and clinic locations with state agencies and insurance payers.                                                                                                                      

JOB FUNCTIONS

• Monitors credentialing policies and recommends improvements.
• Reviews applications and privilege requests. 
• Prepares and tracks credentialing correspondence. 
• Collects and verifies required documentation. 
• Provides credentialing summaries and files to the Peer Review Committee.
• Investigates adverse findings and supports reporting.
• Maintains credentialing records and databases.
• Tracks renewals (licenses, certifications, DEA, etc)
• Credentials providers with insurance payers.
• Enrolls/re-enrolls providers and clinic sites with Medicare/Medicaid to obtain TPI, PTAN, and NPI numbers. 
• Performs other duties as assigned.

MINIMUM QUALIFICATIONS

• Education:
  • Associate Degree, preferred
• Experience:
  • CPCS preferred. 
  • 7+ yrs experience in medical credentialing; or 5+ yrs + CPCS; or 3+ yrs + Associate Degree
• Knowledge:
  • Medicare/Medicaid Enrollment, HRSA/Joint Commission processes, provider privileging.
• Skills:
  • Excellent communication, interpersonal, and customer service skills
  • Detail oriented
  • Data entry
  • Proficient with Microsoft Office (Word, Excel)
  • Confidentiality
  • Time Management
  • Fluent in English, Spanish is a plus.
• Abilities:
  • Must be able to speak, read, write, and comprehend the English language.
  • Ability to sit for majority of the shift.
  • Must be able to bend or stoop.
  • Must be able to lift 20 lbs. unassisted.
  • Must have good vision (e.g, near acuity and depth perception)
• Other:
  • Some local travel between clinic locations. Must keep up immunizations and medical tests as required by the organization.