Job Description

The Credentialing Specialist reports to the Credentialing Manager and is responsible for timely submission and follow-up of payer enrollment applications and credentialing applications for appointment and re-appointment to hospitals and Ambulatory Surgery Centers (ASCs).






Add, update and maintain accurate provider information in CAQH, CredentialStream and other tools commonly utilized for credentialing and payer enrollment. Work closely with providers, internal departments and other team members to obtain necessary information for timely onboarding. Complete, submit, document and pro-actively track and follow-up on required credentialing, enrollment and re-credentialing applications, paying close attention to details. Gather, compile and continuously monitor information necessary for enrollment and credentialing purposes. Update and inform department and other leadership of progress and issues using various means of communication. Research and respond to internal and external inquiries related to enrollment and credentialing issues. Maintain working knowledge of applicable regulations, policies and procedures and understand specific application requirements for both facility credentialing applications and payer enrollment submission. Work collaboratively in a team environment to achieve team and organizational goals by sharing information and resources. May assist other team members with the provider licensing and renewal process. Maintain a high level of confidentiality regarding legal matters, privacy issues and data integrity. Miscellaneous job-related duties as assigned.

Education

: Bachelor's degree

Experience

: 3-5 years of experience in a medical service profession, payer enrollment, insurance plan, revenue cycle, or a combination.


Must be accountable, organized and work independently to self-manage assignments. Knowledge and understanding of the credentialing process; ability to apply principles, procedures, requirements, regulations and policies. Effective communication and interpersonal skills for collaboration with internal teams and external stakeholders. Familiarity with CAQH, Availity, PECOS, NPPES and other common credentialing and payer enrollment tools. Thrive in a fast-paced, dynamic organization with the ability to work with and prioritize multiple assignments and deadlines while adapting to change as priorities shift. Express thoughts and information clearly, concisely and effectively both verbally and in writing. Critical thinker, anticipating next steps. CPCS certified a plus. Experience with CredentialStream preferred. Computer Proficiency, Microsoft Office to include Word, Excel, Power Point.



PRISM Vision Group is an Equal Opportunity / Affirmative Action employer. Candidates are selected solely on the basis of legally permissible job-related criteria without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.


Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.