Job Description

Job Description

Job Description

Summary Description

The Specialist, Credentialing at Secure will organize, maintain and verify all aspects of the process, including but not limited to maintaining current files on individuals with credentialing requirements track files and assist with inquiries.

Key Responsibilities

• The confidential collection, tracking, recording and monitoring of data required in the credentialing/ recredentialing process.
• Accurate, clear and concise external and internal communication to Secure staff and our Partner Network.
• Ensures all new and existing employees/partners meet administrative criteria for employment and participation in our partner network.
• Reviews, compiles, verifies and processes all incoming information submitted by new and existing employees/partners in compliance in accordance with credentialing standards.
• Ensures that all credentialing/recredentialing steps are performed in compliance with contractual requirements, state and regulatory guidelines and that all employees/partners are credentialed according to required timeframes.
• Conduct thorough research and primary source verification of all components of the application file.
• Identify issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up
• Processes and completes provider credentialing and re-credentialing needs; monitors files and follows-up as necessary
• Sets up and maintains provider information in Itineris and Share Drive
• Tracks licenses, training certificates, insurance, and CPR expirations and any other required credentialing document for employees and partners
• Handles telephone calls and assists callers by conveying their issues to the appropriate department
• Maintains knowledge of jurisdictional requirements and document credentialing changes as needed.
• Audit files to ensure up to date information.
• Participates in the development of and adherence to department rules and regulations; and policies pertaining to staff, partners, and the organization
• Utilizes credentialing databases, optimizing efficiency, and performs query, reports, and document generation
• Other duties as assigned and modified at manager's discretion.

Qualifications

• Ability to communicate effectively, both orally and in writing
• Strong research skills to gather pertinent information
• Database management skills including querying, reporting, and document generation
• Knowledge and understanding of the credentialing process
• Ability to organize and prioritize work while managing multiple priorities
• Ability to work with general supervision
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization
• Displays knowledge of key functions, terminology, and work products of legal, information technology, risk management, and performance concepts.

Education/ Experience

· High school diploma or equivalent required.

· Bachelor's Degree Preferred.

· Minimum one (1) year of experience in provider credentialing or in the healthcare industry.

· Knowledge in managed care/insurance credentialing a plus.

· Proficient use of Microsoft Office applications (Word, Excel, Outlook) and internet resources.

Working Conditions

• Office environment
• Remote Office conditions
• Hybrid
• Sitting/standing for prolonged periods of time.

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