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DESCRIPTION OF WORK:             

The Credentialing Specialist contributes to IHC’s mission and goals of client satisfaction, quality of care, cost competitiveness, and productivity by serving as IHC’s functional expert on all steps in the credentialing process. The Credentialing Specialist works with ELT and individuals outside of IHC to ensure that communication, administrative and logistical needs are met with accuracy and efficiency. This position will work with the Executive Leadership Team to provide administrative support as needed.

 Evaluation of performance

Performance will be evaluated based on meeting specific goals and working effectively in a team environment according to policies and procedures established by IHC.

 Application of knowledge

Requires knowledge of an extensive body of rules and/or laws, precedents and procedures applicable to administrative support; knowledge of the employing establishment’s structure, goals, and specialized terminology.

    • Assists with all steps in the onboarding process for new employees, including coordination of provider contracts and orientation scheduling.
    • Helps administer continuing education (CE) benefits.
  • Supports the entire credentialing process, including enrolling providers in all necessary programs, ordering supplies, and updating provider information in appropriate databases both internally and externally.
  • Develops relationships with new and existing provider and nonprovider staff; answers questions regarding employment and contracted benefits as needed.
  • Works with HR department to ensure that all required documents are in place for new employees, including immunization records, degrees, transcripts, CPR certification, etc.
  • Ensures that all IHC personnel files are maintained appropriately to meet all HR requirements.
  • Verifies necessary paperwork for credentialing and re-credentialing of IHC staff, to include licensing, training, and certifications.
  • Assists with Federal Tort Claims Act (FTCA) requirements for all licensed staff to maintain IHC’s malpractice insurance.
  • Works with fiscal department to ensure that new providers are set up correctly with insurance companies for billing purposes.
  • Serves as a point of contact for any external credentialing organization; acts as the liaison between IHC staff and external organizations to ensure that credentialing tasks are completed timely.
  • Works with Talent Acquisition Manager and HR to prepare and send required contracts, forms, etc. to new staff.
  • Responds timely to internal and external inquiries regarding status of enrollment application and file maintenance requests.
  • Researches and/or contacts providers to resolve enrollment application and/or file maintenance deficiencies.
  • Prepares reports for the Board of Directors as requested, including Credentialing Committee reports.
  • Tracks license and other expirations for licensed IHC staff.
  • Performs other duties as assigned.

 

  Job controls and complexity

The Credentialing Specialist, with direction from ELT, makes decisions within the scope of his/her own assignments.

Critical skills and behaviors       

Logic and Analysis – Able to think logically and analytically. Communication and Relationship Building – Able to: Establish and maintain effective and cordial working relationships with staff, board members, provider relations representatives at insurance companies, and visitors. Demonstrate strong attention to detail in verbal and written communication ability, including grammar, punctuation, and spelling skills. Interact with a diverse population with a wide range of educational levels. Demonstrate positive customer service skills. Complete all assignments in an accurate and timely manner. Maintain a high level of confidentiality. Work Product:   Able to: Perform responsibilities accurately, efficiently and timely. Participate in high-performing work teams; maintain a team approach to problem solving. Prioritize, organize, and follow up on multiple tasks in a fast-paced work environment. Process Improvement – Able to: Follow standard work procedures. Participate in process improvement projects as required. Technology –Demonstrate office equipment and computer skills, including data entry; able to use Microsoft Word, Excel, and Outlook, Internet, etc.  Able to learn IHC’s electronic medical records system.

Qualifications

High school diploma or equivalent required. Minimum of 3 years’ experience in administrative support required.  Experience with medical credentialing (at least 1 year) required.

 Physical demands and work environment

Work is considered physically non-strenuous and is primarily sedentary with some walking, standing and carrying of light objects. Must be able to operate general office equipment, including computers, telephone, etc. The work environment is low risk with adequate lighting, ventilation and heat where normal precautions must be observed. Some travel to attend meetings is required.

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Credentialing Specialist

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