Credentialing Specialist

Independent Health Association; Buffalo (NY); Hybrid; USD 28,000 - 32,000; Full time

Benefits offered by this job

Scorecard incentive

Full range of benefits

Generous paid time off

Job summary

Independent Health Association is seeking a Credentialing Specialist to manage timely credentialing and re-credentialing of providers, ensuring accuracy of provider data and compliance with NCQA, DOH, and CMS standards. The role involves HealthRules system oversight and collaboration with internal departments to ensure complete profiles.

The position is hybrid with onsite work at our Williamsville location.

Qualifications

• High School diploma or GED required; Associates Degree preferred.
• Two years of healthcare operations experience required; credentialing experience preferred.
• Experience with HealthRules and Visual Cactus preferred; Windows and Word proficiency valued.
• Strong organizational and time management skills with ability to prioritize to deadlines.
• Ability to work independently and manage a process from start to finish under strict deadlines.
• Excellent written and verbal communication with physicians and providers; strong customer service.
• Demonstrated alignment with IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative, Accountable.

Responsibilities

• Input provider applications into credentialing database and process within required time frame.
• Complete and close routine applications within required time frame.
• Initiate credentialing packets as assigned and scheduled.
• Maintain compliance with Federal, State, NCQA, CMS and IH policies.
• Provide follow-up on conflicting or incomplete information.
• Review and edit files for completeness before analyst review.
• Maintain Network Evaluation profiles for physician network.

Skills

Organizational skills

Time management

Communication skills

Independent worker

Multitasking

Education

High School diploma or GED

Associates Degree preferred

Tools

HealthRules

Cactus (Visual Cactus)

Microsoft Word

Job description

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

Overview

The Credentialing Specialist will be responsible for maintaining the timely and accurate credentialing and re-credentialing of all Independent Health providers. Responsibilities include the management of provider files and documentation in adherence with regulatory requirements and Independent Health policies. The credentials specialist is expected to work with internal departments to ensure the accuracy of the provider data and provide effective, professional external customer service. The specialist will be responsible for maintaining all work through the Healthrules system.

Qualifications

• High School diploma or GED required; Associates Degree preferred.
• Two (2) years of healthcare operations experience required. Credentialing experience preferred.
• Demonstrated experience in Windows and Microsoft Word. Knowledge of HealthRules and Visual Cactus preferred.
• Excellent organizational and time management skills with ability to prioritize work according to established deadlines. Must be able to manage multiple projects.
• Ability to work independently owning a process from start to finish while under strict deadlines and decision-making skills commensurate with position responsibilities.
• Excellent written and verbal communication skills; demonstrated ability to communicate with physicians and health care providers; excellent customer service skills.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Essential Accountabilities

Processing

• Input provider applications into credentialing database and process within required time frame. Ensure that all applications are complete and accurate and in compliance with NCQA, DOH, and CMS standards as well as Independent Health's policy requirements.
• Complete and close clean, routine applications within required time frame.
• Initiate credentialing packets as assigned and scheduled.
• Perform tracking and process to maintain compliance with Federal, State, NCQA, and internal requirements.
• Initiate follow-up and action on any conflicting or incomplete information.
• Complete and close assigned recredential files with required time frame.
• Review and edit file for completeness and accuracy, meeting all regulatory requirements before turning in for analyst review.
• Maintain Network Evaluation process and profiles for physician network. Gather and document information from respective departments and ensure profiles are complete for recredentialing review.

Primary Source Verification

• Perform primary source verification utilizing the credentialing software package according to IPA/WNY policies and procedures.
• Query primary sources by letter or phone for verification of provided information.
• Initiate additional request when response is not received within required time frames.
• Query data bases and utilize internet sources available for verification of license, board information, sanctions, and claims history.

Maintenance

• Maintain the credentialing data base and provider hard copy file.
• Enter all noted changes and update provider credentialing data base record, as applicable in both Cactus and Health Rules.
• Remain current and informed on credentialing policies and procedures.

Reporting

• Generate routine reports as required from the system.
• Provide manager with status report of assigned files at month end.
• Generate reports required for follow-up as needed.

This is a hybrid position with onsite attendance required at our Williamsville location.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $20.00 - $23.00 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

• In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off.

The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affiliation Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.