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Credentialing Specialist

Bloomington, MN 55425

Posted: 07/19/19 Industry: Other Job Number: 00005XY7 Pay Rate: 0.00
Our client in Bloomington, MN has an outstanding opportunity for an experienced Credentialing Specialist to join their healthcare organization. Ideal candidates will be highly self-motivated with a proven expertise in the healthcare physician credentialing, re-credentialing, and provider enrollment. This is a contract-to-hire opportunity paying $20 to $24 per hour.

Credentialing Specialist Information:
• Located in Bloomington, MN
• Monday through Friday; 8:00am to 4:30pm
• Pay: $20 - $24 per hour (DOQ)

Credentialing Specialist Responsibilities:
This Credentialing Specialist is responsible for activities involving all aspects in the coordination of credentialing process including new provider credentialing and re-credentialing of existing physicians and advanced practice providers.

• Coordinates all hospital, payer, and care facilities credentialing/re-credentialing for all Physicians and advanced practice providers.
• Utilizes credentialing software and other computer applications to maintain current and accurate electronic credentialing records and documentation of professional qualifications for all company providers.
• Corresponds with providers and credentialing contacts regarding the need for additional information and/or the status/outcome of the credentialing process.
• Track RN, LPN, and any other licensures that are required for the company s staff members, including provider DEA and professional liability expirations.
• Reviews and screens initial provider credentialing applications for completeness, accuracy, and compliance with federal, state, and local regulations, guidelines, policies, and standards.
• Interprets federal, state, local, and government and insurance agency regulations and guidelines and works towards compliance in every aspect of the position.
• Monitors files to ensure completeness and accuracy; reviews all documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external agencies as appropriate. Perform audits of verified credentialing files upon completion.
• Responsible for being up-to-date and knowledgeable of basic insurance information.
• Reports on the status of processing applications to the appropriate persons. Responds to emails and other correspondence with information requested and/or updates in a timely manner.

Credentialing Specialist Requirements:
• Must be highly self-motivated with a proven expertise and proficiency in the healthcare physician credentialing, re-credentialing, and provider enrollment.
• Knowledge of medical provider credentialing and accreditation principles, processes, procedures, and documentation.
• Knowledge of basic insurance policies, procedures and reimbursement practices.
• Strong computers skills.
• Excellent communication skills with the ability to communicate and work efficiently with manager, administration, physicians, patients, and staff.
• Multitask and work effectively under pressure, accurately complete tasks, and prioritize and meet deadlines.
• Ability to assume responsibility and exercise good judgment in making decisions.
• Represent company in a professional manner related to appearance, communication, and the maintenance of patient and company confidentiality.

Credentialing Specialist Education Requirements:
• Completion of Associates degree preferred plus 2-5 years related experience.
• Certified Provider Credentialing Specialist (CPCS).

Qualified applicants may apply directly to:

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THE RIGHT STAFF is an Equal Opportunity Employer.
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