Credentialing Specialist Supervisor

Description:

GENERAL SUMMARY

The Credentialing Specialist Supervisor is responsible for the oversight of the Credentialing Specialist as well as all application processes for physicians within the corporation in the Managed Care Plans, Medicare & Medicaid as directed by Administration. In addition, this position is responsible for applications for hospital privileges as directed by the corporation. The Credentialing Specialist Supervisor is required to maintain the application files, licensing, and continuing medical education credits as needed, to ensure the most current data is on file and notification is sent to providers when renewal is necessary

Requirements:

ESSENTIAL JOB FUNCTION/COMPETENCIES

The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to:

• Responsible for supervising the Credentialing Specialist(s).
• Is responsible for the full application process of physicians within the Practice in all plans as directed by Administration.
• Manages and updates central physician files, ensuring all required documentation is accurately filed. Maintains these records in compliance with the Practice's confidentiality policies. Files should include, but are not limited to, the physician's current Curriculum Vitae, malpractice history, licenses, CME credits, and hospital privileges.
• Works with practitioners to renew Professional licenses (Prof Lic, CSL, DCL).
• Assists practitioners in maintaining board eligibility by tracking CME’s.
• Maintains Medicaid and Medicare (PECOS) enrollment systems for MIU practitioners in order to stay current and process claims.
• Is responsible for the notification of any licensing and monitoring to ensure timely renewal.
• Communicates any deficient areas of information, timeliness, and/or problems that could affect the reimbursement for services performed.
• Works with the Administration and RCM Managers to ensure that all providers are in all existing managed care plans and completes submission of all physicians into newly negotiated plans.
• Responds to all inquiries regarding the credentialing, licensing, and renewal processes.
• Maintains activity log during the credentialing process to ensure a timely conclusion.
• Is responsible for notification of approval of all credentialing to the various departments within the Practice.
• Works closely with Billing to ensure correction of claim rejection or investigation of auth denials.
• Is responsible for meeting the production and quality standards as set for this position.
• Participate in educational activities.
• Enhance communications by consistently displaying excellent customer service skills in behavior and attitude.
• Performs other position related duties as assigned.
• Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• N/A

KNOWLEDGE | SKILLS | ABILITIES

• Knowledge of provider licensure/malpractice information.
• Knowledge and experience with the Curriculum Vitae structure and Content.
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Ability to work independently and manage deadlines.
• Able to handle multi-tasking processes.
• Ability to prioritize work environment.
• Act as team player: collaborate, communicate clearly, and cooperate with team members.
• Ability to meet standard production requirements.
• Skill in using computer programs and applications including Microsoft Office.
• Complies with HIPAA regulations for patient confidentiality.

EDUCATION REQUIREMENTS

• High School Diploma or equivalent required.

EXPERIENCE REQUIREMENTS

• Minimum of 2+ years credentialing experience.
• Supervisory experiece preferred.

REQUIRED TRAVEL

• N/A

PHYSICAL DEMANDS

Carrying Weight Frequency

1-25 lbs. Frequent from 34% to 66%

26-50 lbs. Occasionally from 2% to 33%

Pushing/Pulling Frequency

1-25 lbs. Seldom, up to 2%

100 + lbs. Seldom, up to 2%

Lifting - Height, Weight Frequency

Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33%

Floor to Chest, 26-50 lbs. Seldom: up to 2%

Floor to Waist, 1-25 lbs. Occasional: from 2% to 33%

Floor to Waist, 26-50 lbs. Seldom: up to 2%