Credentialing - Credentialing Assistant

At Unicare, we strive to provide high quality health care to the community we serve. Our goal is to provide easily accessible, comprehensive, and affordable health care to every family member, while reducing visits to emergency rooms and urgent care facilities. Our mission is to be a community health care organization that treats everyone with dignity and, respect and cultural sensitivity to help create an environment in which all can prosper. 

Job Summary

Credentialing Assistant works in the healthcare field. Primarily responsible for assisting physicians with preparing and submitting credentialing applications. Credentials are given to physicians upon completion of training for specific procedures or in specific fields, certifying the physician is experienced and capable of providing the patient care needed. Credentialing Assistant is employed in a variety of medical office settings.

Duties/Responsibilities:

The following reflects management’s definition of essential functions for this job but does not restrict the tasks that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time with reasonable accommodation.

• Prepare and submit credentialing applications.

Follow up on status of status of applications for physicians and payers and keep a detailed log of all pending and completed work. Commute the results and the status of the applications to physicians, payers, managers and co-workers. Assist in processing initial credentialing and recredentialing applications for physicians, nurse practitioners, and other licensed providers.Collect and verify necessary documentation including licenses, certifications, malpractice insurance, education, training, and work history.Maintain and update credentialing databases and tracking systems with accurate, current information.Ensure timely submission and follow-up on credentialing applications with payers and regulatory bodies.Monitor expiration dates for licenses, certifications, and other credentials; notify providers and update records accordingly.Communicate with providers and departments to resolve missing or incomplete information.File and organize credentialing documentation in physical and/or electronic format as required.Support audits, surveys, and inspections by ensuring credentialing files are complete and compliant.

• Assist with other administrative tasks as needed within the credentialing or HR department.

Non-Essential Functions

• As directed by the Executive Vice President, performs other related and/or necessary tasks to achieve organizational and programmatic goals and objectives.

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Maintain patient confidentiality at all times.
• Must have time management skills and meet deadlines.
• Report to work on time as scheduled as attendance and punctuality is necessary.
• Ability to work well with a multidisciplinary team.
• Ability to problem solve and be self-motivated.
• Maintain regulatory requirements, including all state, federal, and local regulations.
• Represent the organization in a positive and professional manner at all times.
• Comply with all organizational policies and standards regarding ethical business practices. 
• Communicate the mission, ethics and goals of the organization.
• Must have excellent written and oral skills, strong organizational, problem-solving and analytical skills.
• Expected to have strong interpersonal skills and have the ability to understand and follow written/verbal instructions.
• Able to work independently with little or not supervision.
• Must follow directions and be well organized.
• Must have reliable transportation.

Qualifications

§  High school diploma or GED required.

• Previous experience in credentialing, medical staff services, or healthcare administration required.

Knowledge, Skills, and Abilities

• Strong organizational and time-management skills with attention to detail.
• Proficient in Microsoft Office (Word, Excel, Outlook); experience with credentialing software is a plus.
• Office equipment: printers, copiers, and scanners
• Excellent verbal and written communication skills
• Must be detail oriented.
• Must have the ability to work independently with little supervision, but work and communicate well with others when required.
• Ability to handle confidential information with discretion.

Physical Requirements and Environmental Conditions

§  Prolonged periods of sitting and working on a computer

§  Pushing and pulling objects up to 25 Ibs.

§  Frequent wrist, hand, and finger dexterity to perform fine motor function.

§  Position requires light to moderate work with 25Ib. maximum weight to lift and carry.

§  Full range of body motion requires twisting body, pushing, pulling, reaching, bending, stooping, and handling objects with hands and/finger, listening, talking, and/or hearing and seeing.

• Reasonable accommodation will be made to enable individuals with disabilities to perform the essential functions of the position.

Working Conditions

§  Non-Ionizing Radiation (microwaves)

§  Hazardous Exposure (chemical [E.G. Latex] and infectious)

Work Schedule

• You will generally be scheduled to work each day Monday through Friday, with starting times each day varying between 8:00 a.m. and 9:00 a.m. and ending time between 5:00 p.m. and 6:00 p.m., as required to meet the operational needs of the company. There will be occasional Saturdays as needed.

You will need to travel to other clinic locations as needed for cross coverage support.

Our Mission

The mission of Unicare is to be a community health care organization that treats everyone with dignity, respect and cultural sensitivity to help create an environment in which all can prosper.

Let Unicare Community Health Center be your choice that meaningful work that makes a difference in the community we serve.