Credentialing Specialist

Responsible for the credentialing and recredentailing  processes for all medical providers who provide patient care at Strive Health.  Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, payers,  dialiysis centers  and clinics. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

Essential Functions

 

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

·       Completes provider credentialing and recredentialing applications; monitors applications

·       and follows-up as needed.

·       Update each provider’s CAQH database file timely according to the schedule published by CMS

·       Maintains copies of current state licenses, DEA certificates, BLS, Hep. B, TB, malpractice coverage and

·       any other required credentialing documents for all providers.

·       Maintains knowledge of current health plan and agency requirements for credentialing

·       providers.

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

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

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

·       Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid

·       Complete re-credentialing applications for commercial payers

Minimum Qualifications

·       High School Diploma or GED

·       3 years credentialing experience preferred

·       3 years experience in a medical practice business office role required

Preferred Qualifications

• Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
• Excellent computer skills including Excel, Word, and Internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly and effectively

Strive Health offers competitive compensation and benefits.  An annual performance bonus, determined by company and individual performance, is available for many roles and aligned to Strive Health guidelines