ID Care
Credentialing Specialist
ID Care, Hillsborough, New Jersey, United States,
Job Title:
Credentialing Specialist
Department:
Human Resources
Direct Supervisor Title:
Sr. Director of Human Resources
Job Supervisory Responsibilities:
None
Experience Level:
Minimum 3 years in medical credentialing
General Summary:
This is a nonexempt hourly position responsible for ensuring that all providers are appropriately credentialed by both obtaining and maintaining privileges at designated facilities. In addition, they take care of the insurance enrollment with all ID Care's group contracts to provide accurate reimbursement on patient services.
Essential Job Responsibilities:Initiate, complete, and follow-up on all credentialing and privileging applications for providers at all facilities and nursing homes. This includes coordinating, obtaining and/or delivering all necessary requested materials for each facility.Verify physicians' licenses and credentials for privileges at designated hospitals: State licenses, DEA, Board Certification, malpractice/liability insurance.Assist practitioners with the application of Controlled Substance and DEA licenses.Schedule practitioner's interviews with the hospital's Medical Directors.Provide affiliated hospitals with updated credentials: licenses, collaborative agreements, certificate of insurance and documents.Obtain NPI numbers, and update NPPES database with current information.Update CMS profiles, and the PECOS internet database.Input data, update and maintain the CAQH database.Keep current on issues that affect billing, credentialing, and privileges.Maintain all necessary materials for credentialing, including Board certificates, licenses, CME's, PPD testing, etc.Other duties as assigned.Education:
High School diploma is required. Associate's degree Preferred.
Experience:
A physician background with a minimum of 3 years of experience in medical credentialing required.
Other Requirement:
•This position requires an individual who has a background in insurance customer service.
•This position requires an individual who has a background in provider enrollment.
•This position requires an individual who has a background in credentialing.
Performance Requirements:
Knowledge:
1. Knowledge of anatomy and medical terminology.
2. Knowledge and understanding of CAQH system
3. Knowledge and use understanding of PECOS Internet data base.
4. Knowledge of relevant software applications including MS Office.
Skills:
5. Skills in hands-on problem-solving skills and ability to analyze and respond to data.
6. Skill in written and verbal communication and customer insurance relations.
7. Maintains confidentiality of client information and departmental information.
8. Must be able to multi-task and have attention to detail.
Abilities:
Ability to prioritize work and manage time efficiently.Ability to examine documents for accuracy and completeness.Ability to perform well under pressure in a busy medical practice.Ability to independently meet tight deadlines and follow up on open ended items regularly.
Equipment Operated:
Standard office equipment including computers, fax machines, copiers, printers, telephone, scanner, calculator, etc.
Work Environment:
This position is a hybrid position. While in the office, they will be seated in a well-lit office environment with windows allowing the temperature to fluctuate during each season.
Mental/Physical Requirements:
Sitting for long periods of time associated with normal office environment.
Credentialing Specialist
Department:
Human Resources
Direct Supervisor Title:
Sr. Director of Human Resources
Job Supervisory Responsibilities:
None
Experience Level:
Minimum 3 years in medical credentialing
General Summary:
This is a nonexempt hourly position responsible for ensuring that all providers are appropriately credentialed by both obtaining and maintaining privileges at designated facilities. In addition, they take care of the insurance enrollment with all ID Care's group contracts to provide accurate reimbursement on patient services.
Essential Job Responsibilities:Initiate, complete, and follow-up on all credentialing and privileging applications for providers at all facilities and nursing homes. This includes coordinating, obtaining and/or delivering all necessary requested materials for each facility.Verify physicians' licenses and credentials for privileges at designated hospitals: State licenses, DEA, Board Certification, malpractice/liability insurance.Assist practitioners with the application of Controlled Substance and DEA licenses.Schedule practitioner's interviews with the hospital's Medical Directors.Provide affiliated hospitals with updated credentials: licenses, collaborative agreements, certificate of insurance and documents.Obtain NPI numbers, and update NPPES database with current information.Update CMS profiles, and the PECOS internet database.Input data, update and maintain the CAQH database.Keep current on issues that affect billing, credentialing, and privileges.Maintain all necessary materials for credentialing, including Board certificates, licenses, CME's, PPD testing, etc.Other duties as assigned.Education:
High School diploma is required. Associate's degree Preferred.
Experience:
A physician background with a minimum of 3 years of experience in medical credentialing required.
Other Requirement:
•This position requires an individual who has a background in insurance customer service.
•This position requires an individual who has a background in provider enrollment.
•This position requires an individual who has a background in credentialing.
Performance Requirements:
Knowledge:
1. Knowledge of anatomy and medical terminology.
2. Knowledge and understanding of CAQH system
3. Knowledge and use understanding of PECOS Internet data base.
4. Knowledge of relevant software applications including MS Office.
Skills:
5. Skills in hands-on problem-solving skills and ability to analyze and respond to data.
6. Skill in written and verbal communication and customer insurance relations.
7. Maintains confidentiality of client information and departmental information.
8. Must be able to multi-task and have attention to detail.
Abilities:
Ability to prioritize work and manage time efficiently.Ability to examine documents for accuracy and completeness.Ability to perform well under pressure in a busy medical practice.Ability to independently meet tight deadlines and follow up on open ended items regularly.
Equipment Operated:
Standard office equipment including computers, fax machines, copiers, printers, telephone, scanner, calculator, etc.
Work Environment:
This position is a hybrid position. While in the office, they will be seated in a well-lit office environment with windows allowing the temperature to fluctuate during each season.
Mental/Physical Requirements:
Sitting for long periods of time associated with normal office environment.