Specialist, Credentialing

Description POSITION SUMMARY This position primarily reports in person to our Scranton office and may require travel between clinics as needed. Ideal candidates would be local or willing to relocate upon offer. The Credentialing Specialist is responsible for all aspects of the initial credentialing, re-credentialing, privileging and overseeing the credentialing portion of the new hire on-boarding process for all incoming Physicians, Nurse Practitioners, Physician Assistants and other providers as necessary.

Responsible for the application process which includes maintenance of the online application site (CAQH, NPI, etc) forms repository and intake, review and appropriate routing of all credentialing documents. Responsible for the insurance enrollment and facility credentialing. This position liaises with both internal teams and external agencies such as Hospitals, insurance companies, and other programs as needed. In addition to credentialing of providers, the position will maintain certifications, licenses, DEAs and CMEs for medical staff.

Work is performed in an office environment however, this position may offer a hybrid work option with departmental approval on a temporary or ongoing basis, allowing for remote work. Onsite presence is required for projects or team meetings as needed and on site training is required. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job. REPORTING RELATIONSHIPS This position reports to the Credentialing Manager.

This position works closely with the Revenue Cycle Department. This position has no direct reports. ESSENTIAL JOB DUTIES AND FUNCTIONS While living and demonstrating our Core Values, the Credentialing Specialist will: Maintain accurate credentialing, competency, and expirable files in an orderly and current manner for all providers. Record all credentials information immediately upon receipt.

Onboard new providers to ensure all checklist items are completed and up to date Enroll providers and clinic locations with state Medicaid agencies and other payors Coordinate new office openings and update payer/internal rosters Own, track, and manage Medicare, Medicaid, and other third party public and private payor, facility, and provider enrollment and credentialing Develop and maintain relationships with new and existing third-party payors credentialing counterparts and departments Track, organize, and provide timely updates for all credentialing applications Problem solve, troubleshoot, and research credentialing issues independently Create and update training guides, Standard Operating Procedures (SOPs), announcements, and other documentation for the credentialing department Monitor, track, and complete re-credentialing for individual providers and locations and ensure timely…

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