Credentialing Specialist

Summary C2 ALASKA, LLC San Antonio, TX THIS POSITION IS CONTINGENT UPON BID AWARD The Credentialing Specialist verifies all the credentials of incoming healthcare providers, utilizing their knowledge of regulatory standards to remain compliant, and allow the provider to obtain and maintain current privileges Responsibilities Send credentialing packet to provider Communicate to provider all credentialing policies, procedures, protocols, and time restraints Prime Source Verify all necessary credentials i.e., licenses, certifications, background checks Partner with provider to ensure accuracy and completion of all forms completed within time restraints Contact medical office staff/MTF, licensing agencies, insurance carriers, educational institutions, and previous employers for verifications to complete credentialing and re-credentialing applications. Assist in the streamlining of department policies and procedures and workflows to create and maintain replicable processes within the department. Run monthly report on assigned regions, to ensure up-to-date licensures, and certifications Assist in preliminary background checks, to assist recruiting in potential candidate Research classes/courses in the community when needed i.e., BLS, ACLS, etc. Keep manager informed of concerns or problems with provider or credentialing packet Maintains current knowledge of state guidelines and regulatory requirements as well as maintains current knowledge of the credentialing process and applicable database system Communicate effectively to all departments Completes general administrative duties as assigned Identifies and resolves problems in a timely manner Maintains a high level of confidentiality and integrity in dealing with sensitive issues, always exhibiting professionalism Other duties as assigned Qualifications High school diploma Minimum one (1) year credentialing for military installations experience required Knowledge, Skills and Abilities Possesses excellent communicative skills, both verbal and written Working knowledge of NCQA, JCAHO, and HIPPA regulations Ability to read, analyze and interpret common journals Maintains a high level of confidentiality and integrity in dealing with sensitive issues, always exhibiting professionalism Ability to meet and adhere to stringent deadlines Ability to assimilate and implement new information quickly and effectively Knowledge of Microsoft Office Physical Demands (The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee may use repeated motions that include the arms, wrists, hands and/or fingers. The employee is occasionally required to walk, stand, climb, balance, stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision.