Credentialing Specialist

DescriptionThe Credentialing Specialist is responsible for evaluating, analyzing, and managing all aspects of the credentialing and recredentialing processes. This role supports healthcare organizations by ensuring the timely onboarding of providers. The specialist processes applications to meet targeted start dates and renewal deadlines, monitors license renewal activities, and maintains systems to track expiring credentials and certificationsRequirementsEssential Position Responsibilities:Responsible for adherence of credentialing policies and processes, assisting Director with reviewing on an annual basis to meet the National Committee for Quality Assurance (NCQA) standardsSet up Council for Affordable Healthcare (CAQH) accounts for Southeast Medical Group (North Atlanta Primary Care, P.C.) during onboarding process, uploading supporting credentialing documents, and coordinating re-attestations Facilitate and track application paperwork as part of onboarding processIdentify, analyze and resolve information discrepancies that could adversely impact ability to credential and enroll providers, conveys problems to Director for sound decision making in accordance with credentialing policies Primary source verifies documents using NCQA approved sources to ensure compliance with state-specific regulatory credentialing standards as well as individual payor policiesMaintain complete and accurate credentialing files, assisting Director in presenting to Medical Director and/or committee for approvalAssist Director with preparing for delegated credentialing audits and inspection by third party payorsMaintain integrity of database, monitoring compliance and expirable dataMeet targeted credentialing deadlines and start datesParticipate in job-related training, tracking CEUs if required to maintain certificationRequired Qualifications, Knowledge & AbilityAlways observes corporate and client confidentialityAble to prioritize and manage multiple tasks, demonstrating problem solving skills and strong attention to detailDemonstrates effective communication skills both verbally and in writingIntermediate computer proficiency with software programs such as Microsoft Office is requiredCustomer service orientated, actively looking for ways to help othersStrong interpersonal skills and focused on meeting standards of customer satisfaction Handle multiple projects simultaneously and manages time wisely with ability to prioritize and organize tasksIndependent judgement and the ability to exercise decision making without supervisionEducation & Experience RequiredBachelor’s degree or equivalent business-related continuing education required3+ years of experience in medical staff office or credentialing field requiredCertified Provider Credentialing Specialist (CPCS) preferredKey Physical And Mental RequirementsAbility to lift up to 50 poundsAbility to push or pull heavy objects using up to 50 pounds of forceAbility to sit for extended periods of timeAbility to stand for extended periods of timeAbility to use fine motor skills to operate office equipment and/or machineryAbility to receive and comprehend instructions verbally and/or in writingAbility to use logical reasoning for simple and complex problem solvingFLSA Classification: Non-exemptSoutheast Primary Care Partners is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.12/2024