Job Description

The Credentialing Specialist is responsible for all aspects of credentialing and re-credentialing of health care professionals. This position ensures all health care professionals are appropriately credentialed, which includes organizing, maintaining, and verifying all aspects of the process, and maintaining the current information on file within the credentialing database. This position primarily works independently, but frequently coordinates with other team members. Duties/Responsibilities:

• Queries appropriate organizations and evaluates responses to ensure provider compliance with NCQA standards.
• Establishes and maintains a system for timely processing of credentialing/re-credentialing files in accordance with NCQA policies.
• Maintains up-to- date credentialing database.
• Reviews and processes credentialing and re-credentialing files.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Maintains professionalism at all times when communicating credentialing and/or background concerns with any provider.
• Assembles all verified information and prepares files for presentation to the Credentialing Committee
• Assists with ongoing monitoring of contracted providers.
• Reviews all background screenings and record results.
• Utilizes the credentialing database, optimizing efficiency, and performs query, report and document generation.
• Monitors the initial, re-credentialing and expirables process.
• Assists with special projects.
• Verifies providers' requirements for approval to work in specific states and plans.
• Maintains a high level of provider satisfaction.
• Meets all production goals as set by management.
• Assists with off boarding of providers as appropriate.
• Responds to requests for monthly audits.
• Responds to requests from various internal departments.
• Other duties as assigned by the manager.

Required Skills/Abilities/Attributes:

• Excellent verbal and written communication skills.
• Knowledge of Microsoft Office.
• Ability to take instruction from multiple sources and to manage deliverables accordingly.
• Exceptional judgment and active foresight.
• Understanding of the provider tenure process.
• Excellent prioritization and problem-solving skills.
• Ability to consistently maintain quality and production expectations.
• Positive, flexible approach to work and the ability to work on multiple tasks simultaneously and meet multiple hard deadlines.
• Proven time management skills focusing on urgent and overlapping deadlines.
• Ability to professionally handle difficult conversations in person and over the phone.
• Ability to work independently with little supervision, directing workflow to appropriate departments.
• High level of customer service and follow through.
• Ability to work overtime.

Education and Experience:

• High school diploma required.
• Minimum of 1 year of successful work experience in a credentialing or medical staff role.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Ability to lift up to 20 lbs.

Individuals seeking employment at Fusion Health are considered without regard to race, color, religion, national origin, age, sex, gender, gender identity, gender expression, sexual orientation, marital status, pregnancy status, parent or caregiver status, ancestry, political affiliation, veteran and/or military status, physical or mental disability, or any other status protected by federal or state law. Fusion Advantage

Job Tags

Work experience placement, Immediate start, Flexible hours,

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