Credentialing Associate

The Credentialing Associate contributes to the overall success of the department by completing credentialing and re-credentialing cycles and payer enrollment for new and existing Practitioners.

• Responsible for credentialing and re-credentialing (delegated / none delegated) Physicians and Midlevel providers as they join the group.
• Meet all credentialing and re-credentialing timelines in accordance with industry and company standards.
• Create and update provider profiles in credentialing software including provider registration and generating applications.
• Processes primary source verification of provider’ information e.g. license, references, NPDB report, Medicare/Medicaid sanction report, AMA profile, claims history, affiliations, etc.
• Review Provider applications and contact providers for any additional documentation or clarification needed.
• Maintain basic knowledge of credentialing delegation; requirements, oversight and industry standards.
• Responsible for set up and maintenance of all credentialing files in an organized manner and closely monitor information collection.
• Use conscious of all information received and pursue additional information if necessary. Includes analyzing information per policy, NCQA, CMS and ACHA standards.
• Assist in annual review process on timely credentialing, pre-assessments, annual audits, file review and analysis.
• Identify issues that require additional investigation and evaluation.
• Prepare files in accordance with Policy and Guidelines for the Credentialing Committee.
• Ability to manage the pressures associated with setting priorities, handling a large workload, and managing workflow.
• Other duties and responsibilities as deemed necessary according to business needs.

* NOTE:

The list of tasks is illustrative only and is not a comprehensive list of all functions and tasks performed by this position.

• Must be consistent with Femwell’s core values.
• Excellent verbal and written communication skills.
• Professional and tactful interpersonal skills with the ability to interact with a variety of personalities.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with proven ability to meet deadlines and work under pressure.
• Ability to manage and prioritize multiple projects and tasks efficiently.
• Must demonstrate commitment to high professional ethical standards and a diverse workplace.
• Must have excellent listening skills.
• Must have the ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards and organization attendance policies and procedures.
• Must maintain compliance with all personnel policies and procedures.
• Must be self-disciplined, organized, and able to effectively coordinate and collaborate with team members.
• Must have ability to remain focused for long periods of time.
• Extremely proficient with Microsoft Office Suite or related software; as well as Excel, PPT, Internet, Cloud, Forums, Google, and other business tools required for this position.

• Minimum Associate Degree required. Bachelor Degree or Master preferred.
• Minimum of 2 years’ strong computer skills utilizing Microsoft Excel, Word, and data entry software, with experience in manipulating data required.
• Healthcare administration experienced preferred.
• Knowledge of HIPAA Security preferred.
• Hybrid rotation schedule and/or onsite as needed.