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Credentialing Specialist

Credentialing Specialist

We are seeking for an efficient Credentialing Specialist responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers who provide patient care at DebLin Health Concepts & Associates, Inc. You will be responsible for ensuring providers are credentialed, appointed, and privileged with health plans, and patient care facilities. Keep up to date with day to day Credentialing functions.  Will also be responsible for recruiting new providers, setting up interviews for the areas needed.  Will maintain constant communication with multiple departments throughout the company on status of credentialing providers.  Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. He/She will be able to work autonomously and efficiently to ensure the end-to-end running of any credentialing projects and operations. To succeed in this role, you should be familiar using credentialing software and tools.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

1. Compiles and maintains current and accurate data for all providers.

2. Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.

3. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. Keeps up with CAQH Pro-view

4. Maintains corporate provider contract files.

5. Maintains knowledge of current health plan and agency requirements for credentialing providers.

6. Sets up and maintains provider information in online credentialing databases and system.

7. Tracks license and certification expirations for all providers to ensure timely renewals.

8. Ensures practice addresses are current with health plans, agencies and other entities.

9. Processes applications for appointment and reappointment of privileges to DebLin Health Concepts & Associates, Inc.

10. Tracks license, DEA and professional liability expirations for appointed DHC providers.

11. Maintains DHC appointment files, and information in credentialing database.

12. Audits health plan directories for current and accurate provider information.

ADDITIONAL RESPONSIBILITIES:

1. Maintains confidentiality of provider information.

2. Provides credentialing and privileging verifications.

3. Performs other duties as assigned.

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