Imagine Health
  • Cottonwood Heights, UT, USA
  • Full Time

Summary

The Credentialing Specialist will work with staff, and external contacts to complete credentialing services for contracted providers. This role will provide support to our clients, sub-delegates, and providers related to credentialing practices. The Credentialing Specialist will primary source verify, review submitted information, and validate professional qualifications of a provider for approval of contract participation by our Credentialing Committee.

Duties and Responsibilities

  • Maintain and implement best practice credentialing policies and procedures.
  • Credential according to company credentialing policy.
  • Monitor the current credentialing status of practitioners to identify any action needed and complete any research needed. Ensure that all necessary licenses and credentials are verified and updated. This might include contacting licensing boards, reviewing license applications, and obtaining education information.
  • Monitor provider sanctions and complete outreach and internal discussion, as required.
  • Research pended and probated applications and resolve discrepancies.
  • Assist with the establishing a Credentialing Committee. Identify appropriate resources and establish a cadence for the committee meetings and follow ups.
  • Compile and review documentation required by Credentialing Committee.
  • Respond to the most complex provider credentialing, compliance and accreditation issues.
  • Work through delegation oversight and identify ongoing training needs.
  • Update provider data management systems to track credentialing status and to identify network participation.
  • Audit work of other credentialing associates, as needed.
  • Attend, be prepared for, and engaged in meetings as required.
  • Perform any additional tasks as requested by Management.

Education and Experience

  • Bachelors Degree required
  • 3+ years working directly with health care providers or in the health insurance/managed care arena
  • Minimum 5 years credentialing experience in the healthcare industry
  • Knowledge of Credentialing and HIPAA Standards
  • Exposure to the following core courses of study preferred: business administration, communications, health care administration, and marketing
  • CPCS and/or CMSC preferred

Specialized Skills/Knowledge

  • Experience with software, credentialing systems, re-pricing and/or claims payment systems and/or equivalents
  • Effective interpersonal skills with the ability to interact with all levels of management, staff, and providers
  • Inherent desire to be creative and to demonstrate a proactive stance towards generating new and improved ways of doing things and/or opportunities for new initiatives
  • Strong ability to work independently while contributing to a team environment
  • Maintain positive relationships with co-workers and providers
  • Ownership of processes and projects
  • Demonstrated problem solving skills
  • Ability to make sound decisions and act on them
  • Adaptive and open to change and flexibility within job
  • Ability to work in a multi-task environment
  • Ability to stay focused, not allowing for environmental distractions
  • Thorough and attentive to detail
  • Excellent and effective customer service, problem solving and organizational skills
  • Excellent written, verbal and presentation skills
  • Strong computer and analytical skills with proficiency in MS Office Suite
Imagine Health
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