Job Description

Job Description

Job Description

JOB SUMMARY:

This is a highly interactive position that requires the ability to work independently and with a team in a time sensitive environment. This position requires an employee that is organized and capable of juggling multiple projects at one time. The Credentialing Specialist will be responsible for all aspects of contract assignment, credentialing, for Health care professionals from gathering, verifying evaluating highly confidential and sensitive health care credentials consistent with departmental guidelines and accreditation standards. Maintains an optimistic and positive approach to the work and team members.

Qualifications:

• Associate or bachelor’s degree in a health care related field is preferred, or an equivalent combination of education, training, and experience.
• Minimum of two years of healthcare credentialing.
• Ability to deliver clear and comprehensive instructions, verbal or written.
• Ability to problem solve proactively
• Strong follow-up, time management and organizational skills
• Intermediate knowledge of Microsoft Word and Excel
• One year of detail-oriented administrative or customer service experience
• Intermediate to Advanced experience with database systems
• Knowledge of healthcare credentialing and compliance industry protocols preferred
• Previous credentialing experience in a high-volume environment is preferred.
• Intermediate knowledge of Medical Terminology is preferred.

Essential Functions:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

• Efficiently perform all aspects of credentialing verification, including initial credentialing and re-credentialing to ensure current credentials and timely handoff and/or review and approval of Civilian Healthcare files.
• Communicates with internal and external staff and clients in a professional and timely manner.
• Serves as the point of contact and liaison to providers, operations, regulators, and leadership on credentialing related matters.
• Reviews contract requirements in conjunction with the project team and extracts the necessary candidate requirements.
• Manages the initial credentialing process by communicating timelines and requirements to the candidates.
• Coordinates candidate external resources specific to their physical address to satisfy the contract’s credentialing requirements.
• Other duties or special projects as assigned.
• Capable and comfortable dealing with sensitive and confidential information with discretion and trust.
• Reviews credentialing applications for accuracy and completeness to verify provider meets credentialing criteria.

*GiaCare is an equal opportunity employer*

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