Credential Specialist
About The Position
Learn more about us at www.lchcs.com Hours: Monday- Friday, 8:00 am- 5:00 pm Qualifications: An associate's degree is a requirement or experience in medical credentialing. Motivated self-starter and creative problem solver who is comfortable working in a fast-paced, dynamic environment. Experience with Power Point/Excel required. Experience working with reports and spreadsheets is required. Mandatory- Must have previous experience with credentialing and privileging. Job duties include but are not limited to: Compiles and maintains current and accurate data for all providers. Performs primary source verification on all licensed clinical staff. Compiles LIP, OLCP and OCS files for initial privileging and re-privileging and submits to the CMO for approval. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers and these copies are kept in electronic form with a physical backup copy. Maintains accurate provider records and makes edits to Modio profiles. Enter new providers and updates data, as needed. Maintains up to date organizational information on payer portal sites. Verifies data for accuracy completeness. Maintains provider enrollment with insurance plans. Loads providers into CAQH National Database if needed as well as maintain CAQH online services through timely attestation (every 90 days) and uploading of documentation. Sets up and maintains provider information in online credentialing databases and systems. Completes all aspects of Facility Credentialing for each of the Low Country Health Care System sites. Must be a willing problem solver for resolution of claims issues caused by improperly loaded providers into network databases. Understand the connection for revenue with respect to property credentialing physicians into network contracts. Provides any necessary documentation requested by payors/credentialing departments in an expedited manner. Maintains confidentiality of provider information. Performs any other assigned by management. Salary scales are a range of pay and offers are made to applicants based upon the requirements of the particular position. Applicants with “previous like skills” may not be given the same weight and consideration as “previous specific same skills”: i.e., For a Medical Receptionist position, “Previous clerical skills” may not be preferred over “Previous Medical Clerical Skills”
Requirements
- An associate's degree is a requirement or experience in medical credentialing.
- Motivated self-starter and creative problem solver who is comfortable working in a fast-paced, dynamic environment.
- Experience with Power Point/Excel required.
- Experience working with reports and spreadsheets is required.
- Must have previous experience with credentialing and privileging.
Responsibilities
- Compiles and maintains current and accurate data for all providers.
- Performs primary source verification on all licensed clinical staff.
- Compiles LIP, OLCP and OCS files for initial privileging and re-privileging and submits to the CMO for approval.
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers and these copies are kept in electronic form with a physical backup copy.
- Maintains accurate provider records and makes edits to Modio profiles.
- Enter new providers and updates data, as needed.
- Maintains up to date organizational information on payer portal sites.
- Verifies data for accuracy completeness.
- Maintains provider enrollment with insurance plans.
- Loads providers into CAQH National Database if needed as well as maintain CAQH online services through timely attestation (every 90 days) and uploading of documentation.
- Sets up and maintains provider information in online credentialing databases and systems.
- Completes all aspects of Facility Credentialing for each of the Low Country Health Care System sites.
- Must be a willing problem solver for resolution of claims issues caused by improperly loaded providers into network databases.
- Understand the connection for revenue with respect to property credentialing physicians into network contracts.
- Provides any necessary documentation requested by payors/credentialing departments in an expedited manner.
- Maintains confidentiality of provider information.
- Performs any other assigned by management.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
