Credentialing Coordinator Jobs

Credentialing Specialist

Job Summary:

The Credentialing Specialist is responsible for meeting day to day production and quality goals while individually contributing with the processing of provider licenses, credentialing applications, obtaining and completing verification of providers’ medical experience, Drug Enforcement Administration (DEA) registration, Board Certification to evaluate and determine suitability of providers for MindCare Solutions Group and its client partners.

The Credentialing Specialist will process credentialing applications, request information from practitioners and/or other sources as needed, maintain the credentialing database and provider files, request, complete and finalize pending verifications, and ensure providers make it through the credentialing process in a timely manner.

Compensation: $24-$29/hour

Duties/Responsibilities:

• Assist with follow-up on all MSO review comments and necessary investigations.
• Collaborate cross functionally across the organization to support clinical operations.
• Evaluate credentialling processes and procedures and make suggestions for process improvement as necessary.
• Perform other duties as assigned.
• Follow up with external providers and partners timely and professionally.
• Process initial/re-credentialing applications for both internal and external credentialing.
• Request, complete, and finalize all pending verifications.
• Ensure re-credentialing application information is accurate and complete prior to submitting.
• Maintain credentialing databases by ensuring data is entered accurately and in a timely manner.
• Perform primary source verification and credentialing in accordance with regulatory and JCAHO accreditation standards and guidelines.
• Ensure quality and integrity of provider files, and that files are maintained according to all applicable governing agencies and internal quality and security policies, to include both paper and electronic document management.
• Collect client-specific required documentation.
• Identify areas of concern related to application information and request appropriate follow-up information from practitioner or other sources as needed.
• Track pending verification and application issues through committee review.

Required Skills/Abilities:

• Meticulous follow-through of delegated tasks.
• High integrity with excellent problem-solving abilities.
• Understanding of and commitment to appropriate protection of confidential patient information.
• Ability to operate a personal computer and proficient with Microsoft Office Suite and credentialing software (Credential Stream Credentialing Database).
• Excellent written and verbal communication skills with an emphasis on customer service
• Ability to excel in a fast-paced, high-pressure environment, while managing a high volume of email correspondence.
• Strong organizational skills and the ability to manage competing priorities and meet deadlines.
• Strong attention to detail and accuracy.
• Strong interpersonal skills.
• Ability to work independently and as part of a team.

Education and Experience:

• Demonstrated knowledge of regulatory guidelines and requirements for credentialing and recredentialing. Knowledge of Joint Commission accreditation and certification requirements related to credentialing is strongly preferred.
• Certified Provider Credentialing Specialist (CPCS) or equivalent credentialing certification strongly preferred.
• High school diploma required; Associates or Bachelor’s degree preferred.
• 2+ years medical/healthcare credentialing experience; experience within a behavioral health facility/practice, or equivalent, is preferred.