Job Description

Job Description

Job Description

Job Information

Title: Credentialing Specialist

Department: Credentialing

Status: Full-Time

Position Classification/Category: Hourly/non-exempt

Location: Corporate Office

Reports To: Credentialing Supervisor

Summary of Position

Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care at Kintegra Health. This role is responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. He/She will maintain up-to-date data for each provider in a credentialing database to ensure timely renewal of licenses and certifications. 

Minimum Qualifications

Must be able to sit, stand and walk for long periods of time. Able to read and understand the English language. Able to effectively maintain confidentiality of records and communicate with all levels of personnel. Ability to work independently with minimal supervision. Ability to establish and maintain effective working relationships with providers, management staff, and contacts outside the organization. Must be able to work with multiple changing priorities. Requires excellent organizational, problem solving and critical thinking skills. Must be able to interact with individuals of all cultures and levels of authority. Requires the ability to maintain confidentiality. Must be able to function as part of a team. Excellent attention to detail.

Experience: Experience in knowledge and understanding of the credentialing process. Minimum of (3) three years of experience in a healthcare setting.

Additional skills required: Ability to research and analyze data. Proficient use of Microsoft Office applications (Word, Excel, Outlook) and internet. Excellent verbal and written communication skills including letters, memos and emails

Additional skills preferred: MS Access

Education: A combination of experience and/or education/certification. Minimum 3 years’ experience in Credentialing with an Associate-related degree. 

Certification(s)/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.

Key Responsibilities  

1. Compiles and maintains current and accurate data for all providers.
2. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
3. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
4. Maintains corporate provider contract files.
5. Maintains knowledge of current health plans and agency requirements for credentialing providers.
6. Sets up and maintains provider information in online credentialing databases and systems.
7. Tracks license and certification expirations for all providers and practices to ensure timely renewals.
8. Ensures practice addresses are current with health plans, agencies and other entities.
9. Processes applications for appointment and reappointment of privileges.
10. Tracks license, DEA and professional liability expirations for appointed provider

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