Credentialing Specialist

Medical/Healthcare Sparks Glencoe, Maryland


Description

As industry-leading wound care providers, Healing Partners propel standard Skilled Nursing Facility wound care to a completely different level. Our multifaceted approach relieves various burdens – clinical, operational, financial, and practical – from busy owners, administrators, and employees, freeing each staff member to focus optimally on his or her responsibilities and improve overall facility management.

BENEFITS OF WORKING WITH HEALING PARTNERS:

·           Competitive salary/rate

·           Monday-Friday day schedule

·           Benefits: Medical, Dental, Vision, eligible on 1st day of month following start date

·           Employee Assistance Program (EAP)

·           Health Savings Account (HSA)

·           Dependent Care FSA

·           401k, Short Term/Long Term disability and life insurance

·           Tuition Reimbursement

·           Discount Programs

Credentialing Specialist Job Responsibilities:

The Credentialing Specialist will oversee our provider’s credentialing process. They will be responsible for their assigned state rosters, and credentialing at facilities where providers round. They report to the Manager, Credentialing. 

 

Responsibilities 

  • Maintains the credentials of new and existing physician and mid-level providers, their medical licenses, DEA certificates as per state, client and business needs. 
  • Provides credentialing information for new facilities and new provider information with facilities. 
  • Acts as liaison between practitioners and payers, identifies delays with payers, escalates and communicates delays or issues timely. 
  • Build knowledge base for payer requirements and forms. 
  • Maintains credentialing and provider information databases. 
  • Complete any other duties assigned by management. 
  • Audit provider credentialing files, state requirements, and certifications of our facilities to maintain compliance. 
  • Conduct Primary Source Verifications with approved verifications 
  • Conduct yearly, monthly monitoring of backgrounds, state specific checks, Office of Inspector General Checks, SAM, Federal Alerts, and any other checks. 
  • Provide routine follow up with providers, facilities, and stakeholders around credentialing tasks, projects, and issues. 
  • Work on mass credentialing projects as needed. 
  • Assist the Payer Enrollment team as needed on enrollments. 

Credentialing Specialist Qualifications and Requirements:

  • A minimum one year of relevant experience in credentialing, provider enrollment, or related field required. 
  • Excellent interpersonal skills 
  • Excellent communications skills both verbal and written. 
  • Excellent organizational skills and an ability to manage follow-up efforts for multiple tasks. 
  • Focused attention to detail to ensure accuracy and timeliness of credentialing information. 
  • Ability to work under time constraints to meet deadlines. 
  • Proficient use of Microsoft Office applications (Excel, in particular), internet resources and Adobe Acrobat. 
  • Complying with HIPAA policies, Healing Partners Policies and federal/state laws 

 

Physical Requirements:

·           Talk, hear, and communicate with people over the telephone; 

·           Use hands and fingers to operate a computer and telephone;

·           View computer screens for extended periods of time;

·           Sit at a desk for extended periods of time; and

·           Regular, predictable attendance.

 

Work Environment:

·          The job duties and functions for this position are required to be on-site 2-3 days a week.

 

Job Type: Full-time

Salary: $58,000-65,0000

Schedule:

·           Day shift

·           Monday to Friday

·           Weekend and night On-Call

Work Location: Hybrid in Sparks, MD

Healing Partners provides equal employment opportunities to all employees and applicants for employment without regard to race, color, ancestry, national origin, gender, sexual orientation, marital status, religion, age, disability, gender identity, results of genetic testing, or service in the military. Equal employment opportunity applies to all terms and conditions of employment, including hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation, and training.