Credentialing Specialist

Credentialing Specialist

ABOUT BAYLESS INTEGRATED HEALTHCARE

denova Collaborative Healthcare is committed to improving lives and transforming healthcare.  We utilize our Core Values as the foundation for all we do:

Compassionate:  Compassion is the humane quality of understanding the needs of others and wanting to do something about it.  We show kindness and a willingness to help others.  We always provide care for our colleagues, our patients and our community.

Adaptable: The ability of our team to adapt to different environments, conditions and changes is imperative to deliver high quality care.  Adaptable people are open to others while realizing the impact of their own words, tone and body language on others.

Innovative: Our team must have creative and critical thinking in order to introduce new ideas.  Our commitment is creating a comprehensive healthcare delivery system like nothing done, experienced or created before.

Reliable:  As a patient and community centric organization, being reliable is of the utmost importance.  In order to achieve results, we must have a team comprised of consistent and trustworthy individuals that can be counted on to follow through.

Relentless:  We have an unwavering commitment to improve the healthcare system, disrupt the status quo, and create a better community.  We are driven individuals that exemplify intensity and the pursuit of excellence.  A strong work ethic and enthusiasm are necessary in order to help our patients, improve our community, and accomplish our goals.

POSITION SUMMARY

The Credentialing Specialist is responsible for preparing and submitting credentialing applications to all denova payers, and ensures practitioners and managed practices follow Federal, State and other licensing standards by maintaining credentials for practitioners, licensed agencies, private payers and managed care companies.

Primary Job Responsibilities:

• Credentialing specialists maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.
• Create and carry out various credentialing processes in relation to physicians, clinical therapists, physician assistants, nurse practitioners and various other healthcare professionals.
• Ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
• Process applications and reappointment paperwork for practitioners and facilities, checking for full completeness and accuracy.
• Constantly collect and process significant amounts of verification and accreditation information, and thus must constantly maintain and update accurate databases for both practitioners and facilities.
• Maintain NHSC information for employees.
• Maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.
• Other duties as assigned.

QUALIFICATIONS

Education, Certification, and Experience Requirements

• Associate’s or bachelor’s degree in a related field
• One to three years’ experience preferred
• Exceptional communication and time management skills
• Experience with public and private insurers a plus
• Demonstrated leadership skills and the ability to work independently

Tools and Equipment Requirements

• The ability to use a phone, computer, printer, and copier is required.
• Frequent use of Microsoft office products, including but not limited to Outlook, Word, Excel, and PowerPoint.
• The ability to use the internet and various web browser software is required.

Physical Working Conditions and Office Setting Description

• Some travel required to field locations to facilitate execution of responsibilities. Must provide proof of a valid driver’s license, valid auto insurance with, at minimum, state required insurance levels.
• Requires prolonged sitting, standing, frequent bending, stooping, or stretching.
• Some lifting may be required.
• Frequent and prolonged typing and frequent and prolonged operation of computer, keyboard, and telephones required.
• Requires occasional use of fax machines, telephones, copiers, and other office equipment.
• Employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and or move up to 50 pounds.

Other Conditions

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.