Credentialing Specialist

Fresenius Medical Care; Austin (TX); On-site; USD 48,000 - 72,000; Full time

Job summary

Fresenius Medical Care is seeking a Credentialing Specialist to verify credentialing documentation for multiple specialties and ensure timely submissions. You will enter provider data into the credentialing system, maintain files, and monitor expirations while adhering to CMS/NCQA requirements.

High school diploma and 2–4 years of related experience in health insurance or credentialing are preferred. Strong communication and analytical skills, plus proficient computer use, are essential for

Qualifications

• 2–4 years of related experience in health insurance preferred.
• Excellent customer/interpersonal skills.
• Detail oriented with strong analytical and organizational skills.
• Excellent oral and written communication skills.
• Strong computer skills with proficiency in word processing, spreadsheets, databases and email.

Responsibilities

• Verifies and reviews all credentialing items (Medicare, education, training, licenses, malpractice insurance, CLIA).
• Enters provider information and primary source verification data into the credentialing system.
• Creates and maintains provider files in compliance with policies.
• Completes payer enrollment and facility applications timely.
• Obtains missing documents and escalates items to leadership to avoid lapses.
• Maintains data integrity in credentialing records and related databases.
• Performs monthly monitoring of expirations and regulatory requirements.
• Assists with projects and trainings.

Skills

Customer service

Interpersonal skills

Attention to detail

Analytical skills

Organizational skills

Written communication

Oral communication

Computer skills

Education

High School Diploma

Tools

Word processing

Spreadsheets

Database software

Email applications

Job description

PURPOSE AND SCOPE

The Credentialing Specialist is responsible for verifying submitted Credentialing documentation. for all specialties that provide services to the organization's members. The Credentialing Specialist incumbent will meet all credentialing turnaround time levels by submitting accurate and complete applications. The Credentialing Specialist will abide by all policies and processes to meet all state, regulatory, health/safety, and compliance guidelines.

PRINCIPAL DUTIES AND RESPONSIBILITIES

Verifies and reviews all related specialty credentials, including but not limited to Medicare, education, training, licenses, and malpractice/professional liability insurance, CLIA licensure, facility surveys, as applicable. Enters all provider information and primary source verification data into the related database. Creates and maintains provider files in compliance with the organization's policies. Completes payer enrollment and/or facility applications in a timely and complete manner consistent with Department goals and metrics. Responsible for outreach to pertinent parties to obtain any needed documents that go along with credentialing applications as directed. Escalates any missing items as directed to leadership in efforts to stay on task and avoid credentialing lapses Abides by all policies, procedures, and work instructions for the credentialing function, Assists in goals and performance standards management. Ensures data integrity is maintained in related credentialing database and core system records. Improves efficiencies and service provided while reducing costs. Obtains DUNS number and complete online application process in SAMS to ensure the DUNS number is activated Completes yearly revalidations and other requests regarding the DUNS number in SAMS to ensure correct information is loaded in the system to avoid delays in payment and obtaining authorizations Attends trainings and references training materials including content, work instructions, and tools, as required Obtains knowledge of credentialing regulatory and accreditation requirements (CMS, NCQA, etc.). Performs monthly monitoring of expirations. Performs quality checks. Assists with various projects as assigned by direct supervisor. Performs other duties as assigned.

PHYSICAL DEMANDS AND WORKING CONDITIONS

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Little to no travel is required.

SUPERVISION

None

EDUCATION

High School Diploma required

EXPERIENCE AND REQUIRED SKILLS

2-4 years' related experience. Previous experience in health insurance preferred. Excellent customer/interpersonal skills. Detail oriented with strong analytical and organizational skills. Excellent oral and written communication skills. Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database and email applications.

Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.

Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors

Creating a future worth living. For patients. Worldwide. Every day.

Fresenius Medical Care is the world's leading provider of products and services for individuals with kidney disease of which approximately 4.5 million patients worldwide regularly undergo dialysis treatment.

United by a shared purpose of creating a future worth living for chronically and critically ill people, we care for around 292,000 dialysis patients around the globe.

In addition, we operate around 35 global production sites to provide products such as dialysis machines, dialyzers, and related disposables.

We aim to continuously improve our patients’ quality of life by offering them high-quality products as well as innovative technologies and treatment concepts.