Job Description
Description Credentialing Specialist Reports to: Revenue Cycle Director Job Summary: Responsible for all aspects of the credentialing, recredentialing, and privileging processes for all medical providers who provide patient care at Idaho Gastroenterology Associates and Ambulatory Surgery Centers (ASCs). Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
Duties/Responsibilities: • 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.
• Maintains corporate provider contract files.
• Maintains knowledge of current health plans and agency requirements for credentialing providers.
• Sets up and maintains provider information in online credentialing databases and systems.
• Tracks license and certification expirations for all providers to ensure timely renewals.
• Ensures practice addresses are current with health plans, agencies, and other entities.
• Processes applications for appointment and reappointment of privileges to all the ASCs.
• Tracks license, DEA, and professional liability expirations for appointed ASC providers.
• Maintains ASC appointment files and information in the credentialing database.
• Ensures ASC credentialing with payers.
• Responsible for ensuring timely enrollment of new providers with 3rd party and government payers, and maintenance of existing active physicians and advanced practice providers, including BetterDoctor, CAQH, CMS, and ID Medicaid.
• Audits health plan directories for current and accurate provider information.
• May report adverse credentialing actions to appropriate agencies.
• Maintains Confidentiality of provider information.
• Provides credentialing and privileging verifications.
• Maintain onboarding spreadsheet and payer status updates timely.
• Notify payers of provider departures, assist with offboarding of providers.
• Performs other duties as assigned.
Education and Experience: • High school diploma or equivalent.
• Associate or bachelor's degree preferred.
• Certified Provider Credentialing Specialist (CPCS) preferred.
• Two years of relevant credentialing experience.
Required Skills/Abilities: • Excellent verbal and written communication skills, including letters, memos, and emails.
• Knowledge and understanding of the credentialing process.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent attention to detail.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
Physical Requirements: • Prolonged periods of sitting at a desk and working on a computer.
• Requires occasional lifting and carrying items weighing up to 15 pounds unassisted.
Job Tags
Contract work, Work at office,