Job Description:
Summary:
Responsible for the credentialing of practitioners for participation in delegation with managed care payors. The Credentialing Specialist has primary responsibility for the verification of practitioner credentials and the facilitation and coordination of initial credentialing and three-year recredentialing for participation with Integrated Solutions Health Network. Secondary responsibility includes auditing of credentialing files both initial and recredentialing as trained accordingly.
The Credentialing Specialist responsibilities include but not limited to:
• Must complete the credentialing application process in compliance with NCQA standards
• Primary Source Verification (PSV) through outlets such as State Licensing, Federation of State Medical Boards, DEA, OIG, NPDB, and various other agencies is a required component of the position
• Must be able to access all PSV websites as appropriate
• Work in the eVIPs system and appropriately enter and track information for completion of the credentialing process
• Completes notes and sets follow up in the eVIPs system for all information needed
• Must become familiar with both ISHN CVO Policies and Health Plan Policies as well as NCQA standards
• Audit initial and recredentialing as needed
• Assist with NCQA surveys as needed
When file is complete, the Credentialing Specialist assists in preparation of information for the ISHN Credentialing Committee review and approval.
The Credentialing Specialist is responsible for following the credentialing process through to assure that the practitioner is credentialed in a timely manner. The completion of the credentialing process is communicated through the eVIPs system so the proper departments are notified. This allows the proper notification of payors through the delegated credentialing process which in turn allows the timely billing and collection of revenue. The Credentialing Specialist is required to maintain the confidentiality of all practitioner information according to federal, state and system rules and regulations. The Credentialing Specialist will interact with all areas of the organization as well as office managers and practitioners.
Must be able to function independently and function effectively as a team member. Must have strong organizational skills and ability to prioritize work assignments. Must be able to work with frequent interruptions and demonstrate flexibility in response to unexpected changes in work priorities or volume. Computer literacy and knowledge in Microsoft Office required. Professional presentation by appearance, actions, self-development, and guest relations required.
The position requires:
• Familiarity with all Microsoft products as well as Adobe Pro
• A keen attention to detail and focus on timely completion of tasks
• Excellent communication skills
• Must be able to work independently and manage time according to tasks
Requirements:
High School Degree Required (Associates or higher preferred) or one-year relevant experience.
Work Requirements:
Shift: Day
On Call: No
Weekends: No
Travel Required: No Travel
Location:
Ballad Health Corporate
Ballad Health