Credentialing Specialist

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Job description

OnPoint Medical Group is searching for an outstanding Credentialing Specialist to join our team! Come join a great group of medical professionals as our network continues to grow!

OnPoint Medical Group is a physician-led network of skilled Primary and Urgent care providers who are committed to expanding access to quality healthcare in the most effective and affordable manner possible.

Our "Circle of Care" has one primary goal - to ensure the health and wellness of members and their families. We do this by providing access to a comprehensive menu of medical services from one unified physician group in their neighborhoods. With doctors, nurses, specialists, labs and medical records all interlinked and coordinated, patient care has never been in better hands.

OnPoint Medical Group is looking to hire an organized, meticulous, and self-driven Credentialing Specialist to assist us with administrative tasks pertaining to out practitioners' credentialing. The Credentialing Specialist will organize, maintain, and verify all aspects of the process, and maintain current files on practitioners. You will track the expiration of certifications to maintain up to date files, and assist health plan providers and customer with phone inquiries.

The Credentialing Specialist will work in the corporate office in Highlands Ranch, Co. This is not a remote position.

To be successful in this role you should ensure currency and accuracy of all information. Preferred candidates will be reliable, energetic and have excellent people skills.

CREDENTIALING SPECIALIST RESPONSIBILITIES

• Processing initial credentialing and re-credentialing applications

• Screening practitioners' applications and supporting documentation to ascertain their eligibility

• Identifying discrepancies in information and conducting follow-ups

• Maintenance of internal and external databases (CAQH, PECOS, NPPES)

• Assisting customers with credentialing inquiries

• Responding to health plan providers inquiries

• Responsible for follow-up after submission to ensure that health plans appropriately processed the request and that provider information shows correctly on the health plans website

• Audits Health Plan Directory

• CAQH creation and maintenance experience

• Medicare & Medicaid enrollment and revalidation

• Perform provider roster reconciliation

• Initial and reappointment of hospital privileges.

CREDENTIALING SPECIALIST REQUIREMENTS

• High school diploma or GED required (Bachelor's Degree preferred)

• 3+ years credentialing experience

• Certified Provider Credentials Specialist (CPCS) preferred

• Knowledge of Medicare & Medicaid enrollment and revalidation

• Knowledge of medical credentialing and privileging procedures and standards

• Excellent verbal and written communication skills

• Proficient with Microsoft Office Word & Excel (Vlookup)

• Demonstrate skills in problem solving analysis and resolution

• Attention to detail

• Must be able to function independently and as a team

• D emonstrate flexibility in multiple project manager and strict deadlines

CUSTOMER SERVICE EXCELLENCE

• Provide customer service in accordance to practice mission

• Demonstrate ability to be courteous and respectful when interacting with patients and family members

• Maintain patient confidentiality in accordance to policy and procedure and HIPAA requirements

• Enact proper chain of command for patient complaints

LANGUAGE SKILLS

• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations

• Ability to write reports, business correspondence, and procedure manuals

• Ability to effectively present information and respond to questions from groups of managers, patients, and the general public

MATHEMATICAL SKILLS

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals

• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY

• Ability to define problems, collect data, establish facts, and draw valid conclusions

• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables

APTITUDES AND TEMPERAMENTS REQUIRED

• Must have a high level of energy with the ability to adjust to any justifiable pace.

• Make decisions based more on fact than feeling

• Exhibit behavior which emphasizes compassion, quality, loyalty and conscientiousness

• Ability to establish and maintain effective working relationships with patients, their families and staff members

SUPERVISORY RESPONSIBILITIES

This position has no supervisory responsibilities

JOB ELEMENTS/WORKING CONDITIONS

• While performing the duties of this job, the employee is regularly required to stand; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear.

• Travel between sites and locations

• Some flexibility with non-traditional work hours may be needed to accommodate the end-user's schedules during pre and post Go-Lives.

• Occasionally required to walk; sit; and stoop, kneel, crouch, or crawl.

• Frequently lift and/or move up to 10 pounds and occasionally lift and/or move more than 25 pounds.

• Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.

WORK ENVIRONMENT

The above statements describe the general nature and level of work performed by people assigned to this classification. They are not an exhaustive list of all responsibilities, duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

BENEFITS OFFERED

• Health insurance plan options for you and your dependents
• Dental, and Vision, for you and your qualified dependents
• Company Paid life insurance
• Voluntary options for short-term disability, and long-term disability coverage
• AFLAC Plans
• FSA options
• Eligible for 401(k) after 6 months of employment with a 4% match that vests immediately
• Paid Time-Off earned

Salary: $20 - $27 / hour

The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role.

OnPoint Medical Group is an EEO Employer.

Compensation details: 20-27 Hourly Wage

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