Credentialing Specialist

Appalachian Regional Healthcare (ARH); Lexington (KY); On-site; USD 42,000 - 54,000; Full time

Job summary

Appalachian Regional Healthcare (ARH) seeks a Credentialing Specialist to manage credentialing, re-credentialing and privileging for our network. This role reports to the System Director of Medical Affairs and Provider Enrollment, ensuring accuracy and compliance across all provider files.

You will handle pre-applications, prepare packets, verify information, coordinate with Medical Staff Office, and maintain credentialing databases.

Qualifications

• High School diploma required; Associate degree preferred.
• CPCS certification preferred, but not required.
• Two years of credentialing experience preferred.

Responsibilities

• Process pre-applications and prepare packets for provider completion.
• Review credentialing applications for completeness and compliance.
• Coordinate with Medical Staff Office for file submission and approval.
• Maintain online credentialing databases and provider information.
• Communicate with providers and staff to resolve credentialing issues.

Skills

Credentialing process

Organization & prioritization

Verbal & written communication

Attention to detail

Data research & analysis

Independent work

Relationship building

MS Office

Education

High School diploma

Associate degree

CPCS certification

Job description

Overview

The Credentialing Specialist is accountable for performing the credentialing, re-credentialing and privileging process for the organization. The Credentialing Specialist reports directly to the System Director of Medical Affairs and Provider Enrollment.

Responsibilities

Responsible for processing and maintaining credentials files. Responsible for timely and accurate completion of routine and assigned credentialing tasks (see major activities listed).

Specific Activities Include

• Process pre-applications
• Prepare application packets and send to provider for completion
• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy and compliance with organization guidelines, regulations, policies and standards
• Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential practitioners
• Discovers and conveys problems to Medical Affairs for sound decision making in accordance with Medical Staff Bylaws and credentialing policies and procedures
• Participates in the development and implementation of process improvements for the system-wide credentialing process
• Communicates clearly with providers, their liaisons, Medical Affairs, Medical Staff leadership and administration as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise
• Sets up and maintains provider information in online credentialing databases and system
• Maintains professional growth and development through seminars, workshops and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry
• Perform primary source verification for all required elements of the credentialing file
• Coordinate with the Medical Staff Office to submit completed files for recommendation/approval through the Medical Staff process
• Maintains confidentiality of provider information
• Performs miscellaneous job-related duties as assigned

Qualifications

Education

High School diploma required; Associate degree preferred; Certification as a Certified Provider Credentialing Specialist (CPCS) preferred, but not required.

Minimum Work

Experience

Entry Level; two (2) years of relevant credentialing experience preferred.

Required Skills, Knowledge, And Abilities

• Knowledge and understanding of the credentialing process
• Ability to organize and prioritize work and manage multiple priorities
• Excellent verbal and written communication skills including letters, memos and emails
• Excellent attention to detail
• Ability to research and analyze data
• Ability to work independently with minimal supervision
• Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization
• Proficient use of Microsoft Office applications (Word, Excel) and internet resources