Credentialing Specialist

Summary:
Under the general supervision of the Credentialing Manager performs a variety of clerical and administrative functions to provide support and assistance in day-to-day activities of the Patient Financial Service Credentialing Department.

Responsibilities:
Receives incoming requests for enrollment and audits the providers Counsel for Affordable Quality Healthcare (CAQH) account and documentation.



Answers incoming phone calls from providers practice managers directors and health plans.



Handles and resolves provider/practice manager complaints and inquiries via email or phone in a timely and accurate manner.

Processes customer and account source documents by reviewing data for deficiencies; resolves discrepancies by using standard procedures or returning incomplete documents to the team leader for resolution.



Prepares source data for database entry by compiling and sorting information; establishing entry priorities. Enters provider data in requested format for uploading into credentialing database. Inputs new data by running reports and reviewing output.



Verifies entered customer and account data by reviewing correcting deleting or reentering data.



Following policies and procedures and through use of data program techniques maintains provider records in credentialing database by entering new and updated customer and account information.



Reports needed changes for processes and process improvement.



Maintains customer confidence and protects operations by keeping information confidential.



Maintains productivity measures/quality measures as defined by Credentialing Department.



Maintains quality assurance safety environmental and infection control in accordance with established system policies procedures and objectives.



Contribute to team effort by accomplishing related results as needed.



As required assists PFS Credentialing staff in their absence; responding and or forwarding incoming requests; answering phones; taking messages; assisting with a variety of departmental functions.



Participates in educational programs as directed.



Maintains quality assurance safety environmental and infection control in accordance with established system policies procedures and objectives.



Performs other related duties as required.

Other information:
BASIC KNOWLEDGE:



High school level of knowledge or equivalent required. Associate degree preferred.



Minimum one to two years credentialing and or privileging experience within a hospital or managed care environment.



EXPERIENCE:



Must have at least one-year of experience in a health care office environment.



Proven expertise in the healthcare physician credentialing expirables management re-credentialing and provider enrollment environment.



Highly motivated and success-driven with the ability to implement and manage cross-functional projects



Proficient in Microsoft Office. Knowledge of intellicred credentialing software or other electronic credentialing systems is helpful but not required.



Strong organizational and excellent follow-up skills.



Ability to interact effectively with a variety of people (physicians and medical staff offices).



Provide highest level of customer service for both internal and external customers.

Strong written and verbal communication skills. Strong presentation and client interaction skills.

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

Location: Corporate Headquarters USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union