Credentialing Specialist

The Credentialing Specialist provides administrative assistance and oversight of all clinical staff credentialing. Duties include verification of licenses and credentials, maintaining databases, ensuring staff members possess the required licenses and credentials, and coordinating enrollment with payors.

Core Responsibilities & Essential Job Functions

• Credentialing Program:

• Maintain individual practitioner files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications.

• Provide coordination to ensure practitioners' CAQH profiles are up-to-date.

• Maintain practitioner license and certification primary source validations in the data management system.

• Complete credentialing requests from payors and other customers.

• Credential new practitioners and re-credential current practitioners.

• Work closely with the Revenue Cycle Management staff to identify and resolve any denials or authorization issues related to practitioner credentialing.

• Manage user access to the practitioner data management system.

• Other duties as assigned.

• Training and Technical Assistance:

• Provide training and technical assistance to internal and external customers on practitioner credentialing requirements and processes.

• Participate in special projects, and assist with additional duties or tasks, as assigned.

• Department Support

• Monitor queues and assign tickets to appropriate resources for resolution.

• Monitor queues to ensure Service Level Agreements are met.

• Must attend staff meetings, training courses, and other meetings as requested.

Qualifications

Minimum Education, Experience & Training Equivalent to:

• High School Diploma required; bachelor's degree preferred.
• 2+ years of experience in healthcare administration, with experience in credentialing preferred.

Knowledge & Skills:

• Sensitivity to working with an ethnically, linguistically, culturally, and economically diverse population.
• A commitment to the values of the organization while demonstrating good judgment, flexibility, patience

and discretion when dealing with confidential and sensitive matters.

• Expert in Microsoft Office (Outlook, Word, Excel, etc.), especially Excel and related computer software, technology, and databases.

• Consistently demonstrate good judgment and decision-making skills while maintaining the highest level of confidentiality.

• Work in an exciting, fast paced high energy environment while effectively multitasking and managing day-to-day responsibilities without supervision.

• Personable; able to work comfortably with individuals at all levels within the organization.

• Must be highly detail oriented.

• Strong interpersonal skills.

• High level of organizational skills and attention to detail.

• Communicate effectively verbally and in writing.

• Strong working relationships and encourage an environment of teamwork.

• Exercise confidentiality and discretion pertaining to the work environment.

• Positive attitude and a willingness to consider creative solutions to challenges.

• Strong ability to plan and prioritize to meet deadlines.

• Consistently demonstrate good judgment and decision-making skills.

Physical Requirements:

• Must be able to communicate effectively within the work environment, read and write using the primary language within the workplace.

• Visual and auditory ability to work with clients, staff and others in the workplace continuously.

• Frequent speaking and listening (25-75%) to clients, staff, and others in the workplace.

• Utilize computer and cell phone for effective communication.

Conditions of Employment

• Ability to obtain and maintain criminal record clearance through the Department of Justice (DOJ). The People & Performance Department must analyze DOJ/FBI live scan reports in accordance with applicable Federal, State, and Local laws, as well as fitness for the position.

• Ability to obtain and maintain clearance through the Office of Inspector General.

• Must attend any required training.

• COVID-19 vaccination and subsequent boosters required for any in office presence at all company locations.

#Catalight

Company: Catalight

Time Type:

Full time

Compensation:

$30.00 - $35.00 Per Hour

The statements contained in this job description reflect general details as necessary to describe the principal functions of this job. It should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas as deemed fit for the organization.

Catalight is an equal opportunity employer.