Credentialing Specialist

PRIORITY MANAGEMENT GROUP INC in; Pawtucket (RI); On-site; USD 42,000 - 56,000; Full time

Job summary

Priority Management Group Inc in Pawtucket, RI is seeking a Credentialing Specialist to manage initial and re-credentialing applications in compliance with HIPAA, federal and state rules. The role emphasizes accuracy, confidentiality and timely processing.

You will screen applications, investigate discrepancies, maintain credentialing records, and support the Credentialing Team with administrative tasks while delivering superior service to providers.

Qualifications

• High School Diploma or GED required; Associate degree preferred.
• Experience in a medical office/healthcare administrative role.
• HIPAA policies and regulations knowledge.
• Proficient with Microsoft Office, internet resources and Adobe Acrobat.
• Strong interpersonal skills to communicate across levels.
• Fast learner with problem solving abilities.
• Able to organize, prioritize and complete work in a fast-paced setting.
• Reliable with extreme attention to detail and documentation.
• Strong customer service orientation.
• Ability to work independently and as part of a Credentialing Team.

Responsibilities

• Processing initial credentialing and re-credentialing applications per defined processes.
• Screening provider applications and supporting documentation for eligibility.
• Investigating and validating discrepancies and adverse information.
• Responding to external queries regarding provider status.
• Maintaining superior customer service to obtain documentation and complete applications.
• Verifying and documenting expirables.
• Maintaining credentialing database with current information for stakeholders.
• Maintaining confidentiality regarding disciplinary actions or malpractice.
• Assisting the Credentialing Team with additional administrative tasks.

Skills

Attention to detail

Interpersonal skills

Organizational skills

Problem solving

Independent worker

Customer service

Education

High School Diploma or GED

Associate degree

Tools

Microsoft Excel

Job description

Job Details:

Job Location: Pawtucket, RI 02860, Position Type: Full Time

Essential Duties & Responsibilities:

• Processing initial credentialing and re-credentialing applications by uniformly applying clearly defined credentialing or privileging processes to all provider applications based on federal and state regulations and accreditation standards.
• Screening provider applications and supporting documentation to ascertain their eligibility.
• Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, or other sources.
• Provides responses to external queries regarding providers status.
• Maintain superior customer service with providers to obtain supporting documentation and complete applications
• Verifies and documents expirables
• Maintains credentialing database to ensure that accurate and current information is available to all stakeholders
• Maintaining confidentiality with regards to any disciplinary actions or malpractice suits.
• Assisting the Team with additional administrative tasks, as assigned.

Summary of Qualifications:

• High School Diploma or GED required; Associate degree / strongly preferred.
• Experience working in an administrative capacity in a medical office/healthcare setting.
• Complying with HIPAA policies, PMG Policies, and federal/state laws
• Proficient use of Microsoft Office applications (Excel, in particular), internet resources and Adobe Acrobat.
• Successful experience demonstrating the use of interpersonal skills necessary to communicate and gather info from all levels of personnel.
• Quick learner: proven ability to research and problem solve effectively.
• Proven ability to organize, prioritize and complete work, in a fast-paced environment, according to pre-established guidelines.
• Must be reliable and possess extreme attention to detail and documentation.
• Strong customer service orientation.
• Must be able to work independently and as a contributive member of the Credentialing Team.

Physical Requirements:

• Necessitates fine motor skills; occasionally requiring pushing, pulling, lifting and carrying up to 15 lbs.
• Must be able to use a computer, including keyboard and telephone, during peak activity periods, in excess of 8 hours per day and/or 40 hours per week.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

It is the policy of PMG to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, PMG will provide reasonable accommodations for qualified individuals with disabilities.Qualifications: