Credentialing Specialist

• Credentialing Program:

• Maintain individual practitioner files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications.
• Provide coordination to ensure practitioners’ CAQH profiles are up-to-date.
• Maintain practitioner license and certification primary source validations in the data management system.
• Complete credentialing requests from payors and other customers.
• Credential new practitioners and re-credential current practitioners.
• Work closely with the Revenue Cycle Management staff to identify and resolve any denials or authorization issues related to practitioner credentialing.
• Manage user access to the practitioner data management system.
• Other duties as assigned.
• Training and Technical Assistance:

• Provide training and technical assistance to internal and external customers on practitioner credentialing requirements and processes.
• Participate in special projects, and assist with additional duties or tasks, as assigned.
• Department Support

• Monitor queues and assign tickets to appropriate resources for resolution.
• Monitor queues to ensure Service Level Agreements are met.
• Must attend staff meetings, training courses, and other meetings as requested.

• High School Diploma required; bachelor’s degree preferred.

• 2+ years of experience in healthcare administration, with experience in credentialing preferred.

• Sensitivity to working with an ethnically, linguistically, culturally, and economically diverse population.
• A commitment to the values of the organization while demonstrating good judgment, flexibility, patience

• Consistently demonstrate good judgment and decision-making skills while maintaining the highest level of confidentiality.
• Work in an exciting, fast paced high energy environment while effectively multitasking and managing day-to-day responsibilities without supervision.
• Personable; able to work comfortably with individuals at all levels within the organization.
• Must be highly detail oriented.
• Strong interpersonal skills.
• High level of organizational skills and attention to detail.
• Communicate effectively verbally and in writing.
• Strong working relationships and encourage an environment of teamwork.
• Exercise confidentiality and discretion pertaining to the work environment.
• Positive attitude and a willingness to consider creative solutions to challenges.
• Strong ability to plan and prioritize to meet deadlines.
• Consistently demonstrate good judgment and decision-making skills.

• Must be able to communicate effectively within the work environment, read and write using the primary language within the workplace.
• Visual and auditory ability to work with clients, staff and others in the workplace continuously.
• Frequent speaking and listening (25-75%) to clients, staff, and others in the workplace.
• Utilize computer and cell phone for effective communication.

• Ability to obtain and maintain criminal record clearance through the Department of Justice (DOJ). The People & Performance Department must analyze DOJ/FBI live scan reports in accordance with applicable Federal, State, and Local laws, as well as fitness for the position.
• Ability to obtain and maintain clearance through the Office of Inspector General.
• Must attend any required training.
• COVID-19 vaccination and subsequent boosters required for any in office presence at all company locations.

Catalight