POSITION OVERVIEW
The Credentialing Specialist provides administrative support in a hearing healthcare setting. Primary responsibilities include verifying all provider credentials and professional licenses are valid and up to date, providing expertise about health insurance programs, regulations, procedures, and legislative updates, processing and maintaining insurance contracts, and managing database records for these areas.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Obtain and maintain updated copies of required documents on all providers for credentialing applications and track expiration dates and other provider information
- Initiate provider insurance credentialing applications upon hire, track effective and expiration dates, obtain provider signatures as needed, and maintain records per insurance requirements
- Initiate provider hospital credentialing applications, track effective and expiration dates, notify
- provider and direct supervisor of upcoming requirements, and maintain records per hospital
- requirements
- Create new provider credentialing profiles and perform regular updates/maintenance on all
- provider records (i.e. (CAQH, NPPES/NPI, OHCA, Availity, BCBS, United Healthcare) including
- creating and maintaining individual provider account login information
- Ensure all provider licenses and certifications are up to date, renewed on schedule, and entered
- into payroll system for tracking
- Purchase provider professional liability insurance annually, track expiration dates, and post
- receipts to credit card management system
- Submit copies of provider licensure, certifications, and professional liability insurance to outside
- entities annually (i.e. Sooner Start, CommunityCare, Hospitals)
- Schedule Basic Life Support (BLS) training for all patient-facing staff including providers and front
- office staff on a bi-annual basis to maintain certifications
- Provide copies of required documents to partnering hospitals for those providers with
- hospital privileges
- Document and verify qualifications, accreditations, licenses, and insurance for medical professionals and health facilities on an annual basis
- Maintain all group health insurance contracts, fee schedules, and expirations
- Maintain credentialing and insurance databases on an ongoing basis
- Conduct research on updated state and federal regulations and policies
- Release information to requesting agencies and public inquiries when required by law
- Help develop internal credentialing and insurance contract processes
JOB REQUIREMENTS
- 2 years of Provider Credentialing Experience Required
- Strong organizational skills
- Ability to meet strict deadlines
- Attention to detail
- Good communication skills
- Knowledgeable in policies, laws, and procedures
- Strong computer and Microsoft Excel skills
- Proficiency in database management (if applicable)
- Willingness to work as a team player
