Credentialing Specialist

Twin Cities Pain Clinic • Edina, MN

13d • Onsite

About The Position

The Credentialing Specialist role is responsible for all aspects of the privileging and credentialing process for all licensed providers and facilities payors. This role will oversee streamlining, communicating, and facilitating the onboarding and offboarding process for medical professionals and will assist in credentialing and re-credentialing providers with health plans, hospitals, state and federal, and facility licensure tasks.

Requirements

• Associate’s or Bachelor’s degree required.
• Prior experience in Payor/Provider credentialing required.
• Highly self-motivated and able to work with minimal supervision.
• Excellent verbal and written communication skills; interpersonal, customer service, and telephone etiquette skills.
• Proficient in a variety of computer and web-based programs.
• Excellent attention to timeliness, detail, and accuracy.
• Exceptional organizational skills and ability to multitask.
• Highly focused and possess a strong work ethic.
• Knowledge of medical credentialing and privileging procedures and standards.
• Ability to handle confidential information in a professional manner through knowledge of compliance with state and federal laws, including HIPAA.

Responsibilities

• Manage the credentialing and credentialing process for all medical providers for all Clinics and Ambulatory Surgery Centers.
• Serve as the point of contact for the providers and answer any questions about the credentialing/ privileging process.
• Track and maintain up-to-date database of provider credentials, licenses, certifications, training, immunizations, affiliations, DEA’s, etc.
• Ensure compliance with current local, state, and national/federal policies.
• Assist providers in enrolling with various insurance networks and health plans.
• Verify liability and eligibility of medical professionals as well as the authenticity of documents submitted by providers for credentialing.
• Ensure compliance with state and federal regulations regarding provider credentialing, privileging, and licensing.
• Communicate and collaborate with various departments to facilitate smooth onboarding, credentialing, privileging, and reappointment of providers.
• Assist in developing, preparing, and updating credentialing applications, procedures, and policies.
• Submit necessary credentialing applications and information to process internal and external (hospital, payor) privileges or affiliations.
• Adhere to company policies regarding security and confidentiality.
• Maintain confidential records and data, including but not limited to sensitive security information, personnel contact information, background check information, and employer information.
• Other duties as assigned.

Benefits

• A competitive benefits package, including medical, dental, vision, life, and disability insurance, 401(k) plan, PTO time, paid holidays, and HSA plan is offered.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree