Job Description

JOB TITLE: Credential Specialist


GENERAL SUMMARY OF DUTIES: Responsible for all credentialing activities with providers, hospitals, and payers related to privileges for JWM Neurology PC providers.

SUPERVISION RECEIVED: Reports to the CFO / CIO

SUPERVISION EXERCISED: None

ESSENTIAL FUNCTIONS:


1. Maintains the One_App database which has all provider demographic information, licenses, DEA certificates, educational background, board status/certification, CMS status, Insurance credentialing status, liability insurance status/information, and work history.

2. Completes appropriate hospital and insurance/payer applications for new providers

3. Completes application updates with hospitals and insurance/payers as necessary

4. Maintains the CAQH database for providers

5. Completes and updates state licenses, state CDR, and DEA as needed

6. Updates Insurance Company location and provider listings as appropriate

7. Maintains the Medicare 855 forms

8. Assists Business Office with insurance credentialing issues

9. Monitors the Medical Affairs email account

10. The job holder must demonstrate competencies applicable to the job position.

EDUCATION: High School or equivalent

EXPERIENCE: Minimum of two years of healthcare related credentialing as well as other insurance/billing experience in a medical office environment.


REQUIREMENTS: None.

KNOWLEDGE:

1. Healthcare and Insurance credentialing.


2. Knowledge of credentialing database software preferred

3. Knowledge of documents and spreadsheet software desired

4. Knowledge of medical terminology and office procedures

5. Knowledge of third party insurance operating procedures, regulations, and billing requirements and government reimbursement programs.

SKILLS:

1. Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.

ABILITIES:

1. Ability to communicate professionally with internal and external customers.

2. Ability to recognize, evaluate, solve problems, and correct errors.


3. Ability to conceptualize work flow, develop plans, and implement appropriate actions.


4. Ability to maintain confidentiality of sensitive information.


PHYSICAL/MENTAL DEMANDS: Frequent mobility and/or sitting required for extended periods of time. Manual dexterity for using a calculator and computer keyboard. Some bending and stooping required.

ENVIRONMENTAL/WORKING CONDITIONS: Work is performed in an busy office environment and requires both desk and counter work. Frequent contact with employees and outside agencies. Continual patient contact may involve dealing with angry or upset people.


This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

Requirements

1 year business office/insurance billing/coding experience. Inpatient or outpatient credentialing experience

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