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Credentialing Specialist in East Hartford, CT at InterCommunity

Date Posted: 5/25/2018

Job Snapshot

Job Description

Responsible for all aspects of the credentialing, recredentialing and privileging processes for all medical providers who provide patient care at Intercommunity. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Will act as privileging specialist to coordinate, monitor and prepare privileging documentation for all practitioners both in primary care and /or outpatient services.

  • Compiles and maintains current and accurate data for all providers.
  • Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
  • Identifies privileging issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
  • Will process privileging applications using primary and/or secondary source information, research application details and assure processes are in accordance to state and federal regulations.
  • Prepares credentials file for completion and presentation to Credentialing Committee, ensuring file completion within time periods specified.
  • Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  • Maintains corporate provider contract files.
  • Maintains knowledge of current health plan and agency requirements for credentialing providers.
  • Sets up and maintains provider information in online credentialing databases and system.
  • Tracks license and certification expirations for all providers to ensure timely renewals.
  • Ensures practice addresses are current with health plans, agencies and other entities.
  • Processes applications for appointment and reappointment of privileges.
  • Tracks license, DEA and professional liability expirations for appointed providers.
  • Maintains appointment files, and information in credentialing database.
  • Audits health plan directories for current and accurate provider information.
  • Process and maintain Commercial Payor/Health Plan, Medicare and Medicaid Enrollments and revalidation
  • CAQH Registration
  • Maintains confidentiality of provider information.
  • Provides credentialing and privileging verifications.
  • Performs other duties as assigned.

 

 

Job Requirements

Bachelor’s degree or equivalent work experience

Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.

Experience: Two years of relevant credentialing experience.

SKILLS:

  • Knowledge and understanding of the credentialing process.
  • Ability to organize and prioritize work and manage multiple priorities.
  • Excellent verbal and written communication skills including letters, memos and emails.
  • Excellent attention to detail.
  • Ability to research and analyze data.
  • Ability to work independently with minimal supervision.
  • Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization.

Proficient use of Microsoft Office applications

Bi-lingual Spanish / English preferred