Credentialing Specialist

Under the direction of the Director of Human Resources, the Credentialing Specialist performs various tasks which relate to assisting management in the business operations of Southeast Mississippi Rural Health Initiative, Inc. The Credentialing Specialist will 1) obtain verification of and complete processing of providers certification in all areas applicable to that individual provider or facility; 2) complete credentialing documentation for all providers, centers and the corporation with regard to the credentialing process; 3) demonstrate knowledge and skills to appropriately communicate and interact with the staff, patients, families and visitors of all age groups while being sensitive to their cultural and religious beliefs.

Job Responsibilities:

• Demonstrate positive personal attributes such as honesty, integrity and professionalism in all aspects of the job
• Assist Administration in the preparation and distribution of reports, memos and other documents on a timely basis
• Demonstrate strong work ethic by display of attendance, punctuality and dedication to duty, including a willingness to travel and work extended/flexible hours
• Request and monitors credentialing requirement and deadlines for individual providers, each Health Center as well as the Corporation to meet requirements for insurance credentialing in a courteous and timely manner
• Attend all mandatory in-service programs, staff meetings, staff development workshops, conferences and seminars as recommended
• Responsible for updating credentialing information with the various insurance companies and databases, as well as Medicare and Medicaid as it is made available by the providers prior to each deadline
• Responsible for the Re-Credentialing of all facilities and billable Providers both LIP and Other provider types
• Responsible for the construction and maintenance of Credentialing Hard copy file for all LIP, Other Provider and all facilities
• Available for courier service when requested
• Assist in the coordination of verifying, EOB attachment and compiling the documentation needed to file insurance claims for submission to the designated insurance companies
• Work well with all center staff as a team player
• Responsible for completing provider insurance applications in a timely manner
• Demonstrate accurate ability to create and format letters, documents and other correspondence from verbal instruction
• Ability to construct, complete and maintain original forms and other documentation
• Responsible for the completion of the credentialing process for providers in a timely manner
• Able to follow instructions with minimal supervision
• Provide information or assistance to staff or patients when requested and transferring the assistance of that staff or patient to the appropriate personnel as the situation dictates
• Coordinate with Human Resources Staff for coverage of telephone and reception area
• Responsible for filing credentialing documentation in employee files in appropriate sections and in a timely manner
• Ensures confidentiality of patient information and records
• Demonstrates sensitivity to cultural issues and a positive attitude when dealing with patients, colleagues and resource people from outside the center
• Maintains prompt and regular attendance.
• Verify timecard at the end of each pay period.
• Performs related work as assigned.

Job Requirements:

• High school diploma or GED with some college preferred
• Good typing, computer knowledge and working knowledge of all office/business machines and basic office procedures
• Excellent communication and grammar skills
• Minimum 3-5 years executive and/or administrative office experience
• Some medical experience preferred but not required
• Minimum of 2-3 years of credentialing experience, a must
• Must be able to multi-task while handling on-demand requests and deadline pressure
• Must be able to work without supervision while handling the workload
• Must be able to make quick, correct decisions regarding staff when no one else is available
• Demonstrate or and written communication skills including preparing reports, correspondence, and other documentation
• Must be able to determine situations of confidentiality when communicating with staff and outside agencies and be able to handle all situations in a diplomatic manner

Physical and Other Requirements:

• Continuously listen, visualize and have dexterity and eye-hand coordination
• Must frequently sit, squat, reach, use both right and left forearm rotation, walk and stand
• Occasionally kneel, twist, have ability to grasp firmly, lift and carry, push and pull in excess of 10 lbs.