Credentialing Specialist

Bilingual Language Preferred: None
Travel: No Travel Required

Provider Relations / Credentialing Arcadia, California


Description

Provider Relations Coordinator
Credentialing Specialist 

Onsite / In Office

Responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care. Responsible for ensuring providers are credentialed, health plans and appointed at and hospitals. Maintains up-to-date data for each provider in credentialing database and online system; ensures timely renewal of licenses and certifications. Works under supervision of the credentialing manager.  This position maintains a high level of confidentiality, attention to detail, & professionalism and ability to multi-task.

  • Compiles and maintains current and accurate data for all providers.
  • Completes provider credentialing and recredentialing applications; monitors applications and follow-ups as needed.
  • Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  • Individual responsibility for credentialing decisions and authorizing clinician billable service.
  • Maintains knowledge of current health plan and agency requirements for credentialing providers.
  • Sets up and maintains provider information in online credentialing database and system.
  • Tracks license and certification expirations for all providers to ensure timely renewals.
  • Ensures practice addresses are current with health plans, agencies and other entities.
  • Audits health plan directories for current and accurate provider information.

REQUIRED:  At least 2 or more years of related work experience. Equivalent to high school diploma or general education degree (GED).

DESIRABLE:  Associates or Bachelor’s Degree.  Knowledge of MS Word, Excel, PowerPoint, and Care Cloud applications. Experience with credentialing of Healthcare Professionals; experience in the Ophthalmic industry.

CERTIFICATES/LICENSES/REGISTRATIONS:

  • Certified Credentialing Specialist (preferred).