Credentialing Specialst

Under general supervision and co-reporting to the Director of Physician Practice Billing and Executive Director of Revenue Cycle, the Credentialing Specialist coordinates and facilitates the enrollment of Emerson Practice Associates professional providers with various payers for professional services reimbursement. Reviews provider credentialing and/or recredentialing data for accuracy and submission to appropriate billing vendor for payer enrollment. Obtains information from professional providers, databases, and other sources. Completes timely consolidation of required documentation for enrollment process to begin. Continually follows up on enrollment and/or recredentialing statuses until complete. Resolves issues as they are identified in a timely manner. Maintains systems/applications used in the enrollment processes, including but not limited to central provider roster.

Minimum Qualifications

• Education
  • Minimum of a High School Diploma or equivalent is preferred.
  • Associate degree preferred.
• Experience
  • 2 years' experience in a physician medical practice with a basic understanding of various payer billing requirements, claims processing or experience with payer credentialing/enrollment requirements
• Licensure and/or Certification
  • Certified Provider Credentialing Support (CPCS) by the National Association Medical Staff Services preferred.
• Skills
  • Understands the nuances of different insurance types.
  • Proven track record for improving process efficiencies and solving problems.
  • Must be detail-oriented and have excellent organizational skills.
  • Excellent customer service, follow-up, written and verbal communication skills.
  • Excellent analytical and problem-solving skills.
  • Advanced computer skills using word, excel, adobe and web-based applications.
  • Ability to multitask.
  • Ability to effectively build relationships with individuals of all ages, ethnicity, education, and work experience.
  • Understands and maintains confidentiality and all regulations regarding HIPAA.
  • Exhibits professionalism and a friendly demeanor and is a positive representative of the organization over the phone and in person.
  • Reliable, ethical, and honest work ethic
  • Willingness to work as a team player.