Credentialing Specialist

Priority Management Group; Pawtucket (RI); On-site; USD 42,000 - 65,000; Full time

Job summary

Priority Management Group in Pawtucket, RI is seeking a Credentialing Specialist to process initial credentialing and re-credentialing applications in accordance with federal and state regulations. You will screen applications, verify information, maintain the credentialing database, and communicate status with providers while upholding HIPAA policies and delivering excellent service.

The role requires strong attention to detail, excellent organizational skills, and the ability to work

Qualifications

• High school diploma or GED is required; associate degree preferred.
• Experience in a medical office/healthcare setting is a plus.
• HIPAA, PMG policies, and federal/state laws compliance is required.
• Proficient with Microsoft Excel and Adobe Acrobat.
• Excellent communication and organizational skills.

Responsibilities

• Process credentialing and re-credentialing applications using defined processes.
• Screen applications and supporting documents for eligibility.
• Investigate discrepancies and verify information from primary sources.
• Provide status responses to external inquiries about providers.
• Maintain credentialing database with current provider information.
• Maintain confidentiality regarding disciplinary actions and malpractice suits.
• Assist the team with additional administrative tasks as assigned.

Skills

Administrative experience

HIPAA compliance

Customer service

Attention to detail

Teamwork

Interpersonal skills

Problem solving

Education

High School Diploma or GED

Associate degree (preferred)

Tools

Microsoft Office Suite (Excel)

Adobe Acrobat

Job description

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 applicationsVerifies and documents expirablesMaintains credentialing database to ensure that accurate and current information is available to all stakeholdersMaintaining 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 lawsProficient 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.