Credentialing Specialist; Potential to Work from Home

Job: Credentialing Specialist

EEOC: Administrative Support

Status: Non-exempt

Department: Finance

(This job has the flexibility to work from home and work from 32 hours up to 40 in a given week.)

Under limited supervision, manages and monitors processes and procedures that support the credentialing, re-credentialing, expirables data management, and delegated credentialing contract processes. Oversees all of the credentialing functions including application management and primary source verification. Ensures compliance with the appropriate accrediting and regulatory agencies.

• Serves as company liaison with 3rd party payors
• Manages update to date information regarding fee schedules
• Manages and updates credentialing & clinic licensure policies and protocols
• Ensures reports on credentialing status of providers is up to date and accurate
• Defines and implements processes to ensure credentialing is completed and up to date in a timely manner
• Manages process of negotiating new insurance contracts
• Ensures all clinic information is accurate within 3rd party payor directory
• Drives and implement seamless protocols for gathering credentialing data from health care providers

• High school education required
• Medical practice experience, surgical practice experience preferred
• Excellent verbal and written communication skills
• Efficiency and organizational skills
• Administrative skills
• Computer literacy and adaptive to new technology

PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly);
Lifting 25 lbs max;
Carrying of objects up to 25 lbs;
Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS:
Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to:
Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, and environmental conditions may vary depending on assigned work area and work tasks.