Job Description

The Credentialing Specialist coordinates and completes hospital, licensing, and managed care credentialing documentation (pre-applicant and initial applications, reapplications, and other applicant forms) for providers; assisting in the maintenance of credentialing database and maintaining files and supporting documents for the providers.

JOB RESPONSIBILITIES

ESSENTIAL FUNCTIONS:

• Coordinate and complete all aspects of provider credentialing for all contracted facilities, including professional liability coverage, initial and reappointment applications, and payer enrollment/managed care forms, as directed by the management.
• Complete credentialing processes for on-boarding new physicians and for exiting physicians.
• Assist providers in obtaining state licensure and in renewing existing state licenses.
• Maintain current state license statuses and documentation.
• Ability to comply with accreditation standards and regulations.
• Extensive data entry within the physician credentialing databases and spreadsheets.
• Data entry of completed CME courses and expiring documentation for providers.
• Demonstrate ability to exercise independent judgment as well as ability to function as a contributing member of a team.
• Maintenance of provider rosters for outside vendors for professional liability insurance and payer enrollment.
• Post-onboarding and in-house re-credentialing audits.
• Serve as a primary point of contact for providers concerning all aspects of the credentialing and/or licensing processes.
• Update correspondence to lead and providers detailing current statuses pertaining to provider applications as well as communicating yellow or red flags occurring within the credentialing process.
• Perform all job responsibilities in alignment with the industry's best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
• Become familiar with and abide by the Corporate Compliance Program and all corporate policies, including the Privacy and Security Policies.
• Serve as a point of contact for third party payer enrollment for providers and coordinate with managed care departments.
• Coordinate and/or collaborate with other departments within Pathologist Biomedical Laboratories, Southeastern Pathology Associates, and subsidiaries.

Qualifications

EDUCATION & LICENSURE:

• High School Diploma or G.E.D. is required.
• Two to three years of prior job-related credentialing experience preferred.

SKILLS AND QUALIFICATIONS:

• Experience in healthcare required.
• Knowledge of medical terminology, physician credentialing, and previous database/document control system experience strongly preferred.
• Professional and effective communication and customer service (both written and verbal).
• Demonstrate ability to perform tasks with a high degree of accuracy and quality.
• Ability to multitask.
• Proficiency in use of MS Office products (Excel, Outlook, Word, Teams) and other computer applications.