Credentialing & Admin Support Specialist

Greater Baden Medical Services, Inc.•Brandywine, MD

1d•Onsite

About The Position

Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers and clinical staff who provide patient care. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Additionally providing administrative and onboarding support to the Recruitment Manager as required.

Requirements

Associates or Bachelor’s Degree in Business Administration, Healthcare
Or equivalent certification of competency and three (3) to five (5) years of work experience in medical credentialing
At least two (2) years of experience working in the healthcare industry or similar regulatory environment
Experience working with local, state and federal agencies in regards to procuring licensing for healthcare providers including background checks

Nice To Haves

Certified Provider Credentialing Specialist (CPCS)

Responsibilities

Maintains credentialing files in adherence to HRSA guidelines as it pertains to the credentialing and privileging clinical staff guidelines.
Maintains communications with insurance vendor to ensure providers are up to date. Reviews and ensures documents submitted are current and correct.
Provides timely information to the agent (internal/external) who is charged with monitoring the insurance portals.
Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
Provides administrative and onboarding support to the Recruitment Manager, including timely outreach to new clinical staff, conduct reference checks and coordination of required documentation as directed.
Processes applications for appointment and reappointment of privileges within time sensitive deadline.
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
Tracks license, DEA and professional liability expirations for appointed providers.
Compiles and Ensures that accurate licenses, DEA and professional liability documents are secured and maintained in all providers’ files.
Compiles and Ensures current CPR and First Aid certificates are maintained in providers’ files
Works in tandem with the Director of Clinical Education and Support regarding providers re-training in CPR and First Aid. Provides copies of updated certificates to the Director of Clinical Education and Support.
Maintains corporate provider contract files.
Maintains knowledge of current health plan and agency requirements for credentialing providers.
Sets up and maintains provider information in online credentialing databases (CCNV) and system.
Tracks license and certification expirations for all providers to ensure timely renewals.
Routinely communicates with agent on the status of filings with insurance companies.
Ensures practice addresses are current with health plans, agencies and other entities.
Audits health plan directories for current and accurate provider information.
Assist with the new hire process for LIP’s and OLIP’s
Provide assistance with provider chart review.
By maintaining providers’ credentialing files, ensures that a healthcare facility is operating within state and federal regulations.