Physician Credentialing Specialist

Description

This job description is a record of the essential functions of the listed job. The job description provides the employee, CEO, Human Resources, applicants, and other agencies with a clear understanding of the job, where it fits into the organization, and the skill and work requirements in relation to other jobs. Jobs are always changing to some degree and the existence of the approved job description is not intended to limit normal change and growth. The facility will make reasonable accommodations to otherwise qualified individuals who are capable of performing the essential functions of the job with or without reasonable accommodation.

POPULATION SERVED

The position does not involve direct patient care for a population of patients ages 18 and older. Age specific experience and/or special training and/or expertise are not required to serve this population.

POSITION SUMMARY

The Physician Credentialing Specialist is responsible for credentialing new providers and maintain current provider files for the growing multi-specialty physician group. They are responsible for submitting and tracking credentialing applications to various contracted insurances for oncoming providers. They will maintain the data for all providers within the group, track the expiration of certification and licenses, and will act as a liaison between hospital administration and medical staff, including physicians.

POSITION QUALIFICATIONS

At least three (3) years of medical services experience is preferred. Knowledge of medical terminology, strong organization skills, good written communication skills, ability to work independently, and ability to conduct research while performing job duties is required. The position also requires a person who is able to communicate well with all levels of staff, physicians, and patient referral sources. He/she is flexible, responsible for assignments, and supportive of team efforts. The duties and responsibilities are listed below. It is the expectation of the American Advanced Management that the employee be able to demonstrate competency in each area. It is the duty of the company to provide orientation and performance evaluation in each area stated.

DUTIES AND RESPONSIBILITIES

JOB DUTIES

• Ensures all necessary licenses and credentials are verified and updated for the facility
• Conduct background checks
• Contact licensing boards
• Review license applications
• Obtain education information
• Complete references
• Ensure the facility is operating within state and federal regulations

BUSINESS DEVELOPMENT

• Creates and continually cultivates business development and growth.
• Creates and leads a culture centered on business development and customer service.
• Models customer service to patients, families, staff, physicians, and the referral community.

TRAVEL

• Travel is primarily local during the business day, although some out-of-the area and overnight travel may be expected.

ETHICS

• Consistently behaves in a professional and ethical manner, adhering to all policies related
• Meets and abides by all compliance, HIPAA, and professional standards.
• Performs all other tasks and duties as may be assigned.
• Dresses and presents self in a professional manner at all times. Adherence to the hospital appearance policy is required.
• Wears company issued nametag at all times.

Requirements

At least three (3) years of medical services experience is preferred. Knowledge of medical terminology, strong organization skills, good written communication skills, ability to work independently, and ability to conduct research while performing job duties is required. The position also requires a person who is able to communicate well with all levels of staff, physicians, and patient referral sources. He/she is flexible, responsible for assignments, and supportive of team efforts. The duties and responsibilities are listed below. It is the expectation of the American Advanced Management that the employee be able to demonstrate competency in each area. It is the duty of the company to provide orientation and performance evaluation in each area stated.