Credentialing Specialist

Description

Primary Objective

This position is responsible for verifying professional credentials and processing the information in compliance with all regulatory standards by performing duties within the scope of the policy and procedures defined by Charlotte Eye Ear Nose and Throat Associates.

Essential Functions

• Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications
• Maintain accurate provider profiles on CAQH, NPPES and CMS databases
• Complete credentialing applications to add providers to commercial payers, CMS and Medicaid
• Complete re-credentialing requests issued by government and commercial payers
• Verify and maintain provider hospital privileges within CredentialStream
• Ensures all individual provider locations within the practitioner database match the CEENTA location reports
• Work closely with the Business Office to identify and resolve any denials or authorization issues related to credentialing
• Maintain the provider flu and PPD grids and forward to appropriate staff
• Update and/or provide verification of all payer directories via electronic submission, email (spreadsheets) and/or phone
• Provides profile updates/verifications for active and termed CEENTA providers to various facilities
• Maintain and submit monthly credentialing allocation reports
• Other responsibilities may be assigned by the Credentialing Manager
• Ability to meet the physical and mental demands of the position
• The ability to work on-site. Remote work eligible after probationary period
• Predictable, reliable, and prompt attendance
  
  

Skills And Abilities

• Extremely high level of attention to detail
• Ability to follow procedures and processes in accordance with CEENTA standards and CMS guidelines
• Proficient in Microsoft applications including Excel, Word and Outlook / Office365 required
• Maintain proficiency with office equipment utilized to perform duties which includes dual monitors, printers, and OnBase faxing program
• The ability to multi-task and prioritize work is required
  
  

Core Competencies

• High level of attention to detail
• Building trust
• Communication
• Follow-up
• Professionalism
  
  

Clinical Competencies

N/A

Training Period

30-90 days

Accountability

Our mission is to be the premier eye, ear, nose, and throat group providing comprehensive, quality, and ethical healthcare to all in the Carolinas; to provide a favorable environment for the delivery of healthcare; and to provide for the wellbeing of the physicians and the employees of Charlotte Eye Ear Nose & Throat Associates, P.A.

The selected candidate must be reliable and dependable.

Qualifications

Education

High School diploma or general education degree (GED)

Experience

• 2 years’ medical staff credentialing experience required
• 2 years’ experience in a medical practice business office role preferred
• Experience with credentialing software packages, NPPES, PECOS and CAQH enrollment
  
  

Certificates, Licenses, Registrations

NAMSS CPSC Certification Preferred, Not Required

Work Environment

The work environment characteristics described are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities

This position has no supervisory responsibilities

Position Type and Expected Hours of Work

Full-time. Standard hours of operation (and working hours): 8am-5pm, Monday-Friday. Additional evening/weekend hours may be required to complete system updates

Upon successful completion of a probationary period and in good standing, employee is eligible for remote work

Physical, Mental Other Requirements

The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Requires sitting for long periods of time with repetitive movements, such as typing
• Sitting at least 90% of the time
• Must be able to work independently and in a group setting
• Requires a high level of attention to detail
  
  

Other Requirements

• Active & Current Driver’s license
• Clean driving record
• Consistent and Reliable Transportation
• Polite and professional disposition
  
  

Travel

Less than 10% travel

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. In addition to those essential functions identified above, individuals in this position are also responsible for performing other duties or tasks that may be assigned. CEENTA retains the discretion to add or change the essential job functions of this position at any time without notice.

A Typical Day in the Position

90% of the work will be performed on a computer with dual monitors. This position is responsible for answering incoming calls, processing incoming correspondence and updating provider demographics into the credentialing database, as well as other pertinent information. Daily interaction with providers and practice managers. This position is also responsible for data entry of credentialing and insurance information, responding to credentialing inquiries, and retrieving/sending faxes as part of their daily responsibilities.