Credentialing Specialist

Saint Joseph Medical Group; London (KY); On-site; USD 45,000 - 65,000; Full time

Job summary

CHI Saint Joseph Medical Group in Kentucky is seeking a Credentialing Professional to coordinate credentialing, re-credentialing, and payer enrollment for providers in line with delegated agreements and regulatory requirements.

You will manage daily credentialing operations, resolve non-responsive providers, and collaborate with clinic managers and the medical staff office to ensure timely completion and compliance of the credentialing processes.

Qualifications

• Degree in Business or health related field and experience with Microsoft Word, Excel, and Website applications.
• Preferred credentials: Certified Provider Credentialing Specialist and Prof Medical Services Manager.

Responsibilities

• Facilitates credentialing and re-credentialing for all physicians.
• Assist with processing pre-applications, provisional reviews, and periodic review of privilege criteria.
• Systematically evaluate work processes.
• Participate in conception, development and implementation of new programs.
• Maintains the medical staff database to ensure the upmost integrity of the system.

Skills

Organizational skills

Communication skills

Regulatory knowledge

Education

Degree in Business or health related field

Certified Provider Credentialing Specialist

Tools

Microsoft Word

Microsoft Excel

Website applications

Job description

Job Summary and Responsibilities

As a Credentialing Professional, you will be responsible for coordinating the credentialing, re-credentialing, and payer enrollment process for providers in accordance with delegated credentialing agreements, policies and procedures, industry best practices, and regulatory requirements.

Every day you will manage daily credentialing operations, including resolution of non-responsive providers. You will also work collaboratively with various clinic managers and the hospital medical staff office to ensure the successful and timely completion of the delegated credentialing and re-credentialing process.

To be successful in this role, you will demonstrate a comprehensive understanding of credentialing regulations and processes, possess strong organizational and communication skills, and effectively manage complex administrative tasks to ensure provider compliance and efficient operational flow.

• Facilitates credentialing and re-credentialing for all physicians.
• Assist with processing pre-applications, provisional reviews, and periodic review of privilege criteria.
• Systematically evaluate work processes.
• Participate in conception, development and implementation of new programs.
• Maintains the medical staff database to ensure the upmost integrity of the system.

Job Requirements

Required

• Degree in Business or health related field and Experience with Microsoft Word, Excel, and Website applications, upon hire

Preferred

• Certified Provider Credentialing Specialist, upon hire or
• Prof Medical Services Manager, upon hire

Where You'll Work

Welcome to CHI Saint Joseph Medical Group, a full service network of primary care services specializing in family, internal, geriatric and pediatric care serving 88 locations across central and Eastern Kentucky. CHI Saint Joseph Medical Group is dedicated to delivering customized care based on the unique needs of our patients and is recognized as a Best Place to Work in Kentucky for two years in a row (2023-2024).

CHI Saint Joseph Health is part of CommonSpirit Health, a non-profit, Catholic health system dedicated to advancing health for all people. With approximately 175,000 team members and 25,000 physicians and advanced practice clinicians.

Our commitment to serve the common good is delivered through the dedicated work of thousands of physicians, advanced practice clinicians, nurses, and staff; through clinical excellence delivered across a system of 140 hospitals and more than 2,200 care centers serving 24 states.