Credentialing Specialist

All Star is looking for detail-oriented individual to work in a fast-paced, team-centric environment medical staff services role. The Credentialing Specialist is responsible for maintaining the credentialing and re-credentialing process for All Star healthcare providers. Additionally, the Credentialing Specialist will contact the medical office staff and insurance providers, as well as communicating with healthcare personnel to maintain up-to-date files on physicians and NP/PA. The Credentialing Specialist is also responsible for answering inquiries regarding providers' credential status and working with the locum’s division to ensure the accuracy of all files by tracking the expiration of licenses and certifications.

· Compiles and maintains current and accurate data for all providers

· Conduct thorough research and primary source verification of all components of the application file

· Identify issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up under supervision from Supervisor, Internal Credentialing

· Processes and completes provider credentialing and re-credentialing applications

· Sets up and maintains provider information in the CRM and shared drives

· Process applications for appointment and reappointment of privileges

· Tracks licenses, DEA certificates and professional liability expirations and any other required credentialing document for appointed providers

· Handles telephone calls and assists callers by conveying their issues to the appropriate individual or department and performing follow-up, as required

· Communicates credentialing requirements and documents as needed

· Maintains knowledge of jurisdictional requirements and document credentialing changes as needed

· Assists with internal file audits

· Participates in the development of and adherence to: department rules and regulations; and policies pertaining to medical staff, practitioner/provider, and the organization

· Utilizes credentialing databases, optimizing efficiency, and performs query, reports, and document generation; submits and retrieves National Practitioner Data Bank reports in accordance with Healthcare Quality Improvement Act

· Other duties as assigned and modified at manager’s discretion

· Strong attention to detail

· Ability to organize and prioritize work and manage multiple priorities

· Ability to communicate effectively, both orally and in writing

· Database management skills including querying, reporting, and document generation

· Knowledge and understanding of the credentialing process

· Ability to work with general supervision

· Ability to analyze, interpret and draw inferences from research findings, and prepare reports

· Working knowledge of clinical and/or hospital operations and procedures

· Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization

· Experience in related field preferred

· Experience in Healthcare Staffing or managed care/insurance credentialing a plus

· Familiarity with data entry procedures and a large-scale database system (CRM)