Credentialing Specialist

General Summary of Duties: Performs a variety of functions for all aspects of the enrollment and credentialing process of providers and their participation with affiliated health care plans/facilities.

Typical Physical Demands: May be exposed to short, intermittent, and/or prolonged periods of sitting and/or standing in performance of job duties. May also require some bending, stooping, stretching, and walking at times. Requires hand-eye coordination and manual dexterity sufficient to operate a computer/typewriter keyboard, photocopier, telephone, facsimile, calculator, and other office equipment. Require normal range of hearing and eyesight to prepare and communicate appropriate reports.

Occasionally requires lifting papers or boxes weighing up to 50 pounds. It is necessary to view and type on computer screens for long periods of time.

Typical Working Condition: Work is performed in an office environment.

Involves frequent contact with staff and the public.

Examples of Duties: (This list may not include all of the duties assigned)

• Enroll new providers in health plans and existing providers in newly contracted health care plans to include compilation of confidential data
• Knowledge of health plan enrollment and credentialing procedures.
• Credential all providers to include; Physicians, Nurse Practitioners, Physician Assistants and Surgical Assistants with affiliated health plans/healthcare facilities.
• Responsible for recredentialing of providers, which occurs every 2 -3 years.
• Responsible for the enrollment of all hospital and practice-employed Nurse
  Practitioners and Physician Assistants with the contracted health plans.
• Maintain accuracy of provider database.
• Maintain and track provider licensure, requesting current version from appropriate parties when necessary.
• Develop and implement reporting mechanisms to keep providers and administrators apprised of providers health care plan status.
• Coordinate with local community hospitals/surgery centers to ensure that proper documents are obtained and processed to determine hospital privileges.
• Develop and maintain excellent working relationships with the health plan/facility contacts regarding provider enrollments and credentialing.
• Maintains confidential records and files.
• Participates in educational activities and programs.
• Performs related work as required or assigned.

Performance Requirements

Knowledge, Skills, & Abilities: Requires strong verbal, quantitative and analytical skills. Knowledge of health plan credentialing, recredentialing and enrollment process; licensure requirements and regulations of various agencies. Ability to work in a fast-paced environment and prioritize multiple demands. Must possess a high level of service-oriented skills and the ability to maintain calm in a high-pressure environment. Ability to interact with staff at all levels. Ability to develop and maintain workflow systems, which require excellent follow through and attention to detail. Ability to work independently. Ability to interact professionally with staff of multiple internal and external entities and to do so in a manner that results in high levels of customer satisfaction.

Education:

High school diploma or GED. Associate Degree in Business

Administration or Secretarial Program preferred.

Experience: Three years of secretarial experience including one year in a health care organization to include credentialing. Computer experience required.

Certificate/License: None.

Alternative to Minimum Qualifications: Additional appropriate education may be substituted for secretarial experience.

Current Openings for Credentialing Specialist Jobs at Bond Clinic

Job Title	Department	Location	Closing Date	Employment Type
Credentialing Specialist	Administration	Winter Haven, FL, US	17-May-2024 (EST)	Full Time

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