Responsible for maintaining all medical staff credentialing files both active and inactive, per hospital policy and The Joint Commission guidelines. Has the responsibility of communicating with all Providers & outside agencies in regard to credentialing. In addition, the Credentialing Specialist will be responsible for processing all tasks related to payor enrollment for entities and individual providers including new credentialing, revalidations, demographic verifications, CAQH maintenance, internal database management and reporting. Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and recredentialing applications.

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

The Credentialing Specialist is expected to perform the following essential functions:

• Process all medical staff credentialing applications. Communicate with Credentialing Verification Organization to ensure all providers are properly credentialed.
• Maintain all credentialing files in a well-organized secure file that meets The Joint Commission requirements.
• Maintain a database of all providers names, license, education, and appointments.
• Verify and maintain all provider required licensure in Credential/Education files.
• Maintain secure Credential/Education files on all staff in accordance with hospital policy and certification agency guidelines.
• Enroll providers with participating insurances.
• Follow up with clients and insurances in accordance with established guidelines for all credentialing assignments.
• Communicate clearly and effectively with providers, staff, Executive Directors and insurance companies in handling basic questions and dealing with the day-to-day operation of credentialing and enrollments.
• Perform primary license verification on all providers upon initial hire and renewal.
• Update provider CAQH profiles to ensure provider insurance reimbursement.
• Add, drop, and change provider malpractice insurance with carrier.
• Maintain insurance payer website with updated provider rosters.
• Prepare credentials for presentation to medical staff for approval.
• Perform all other tasks as requested by management.

• Must possess a thorough knowledge of credentialing principles.
• Must possess general knowledge of provider licensing requirements.
• Must possess professionalism, excellent communication skills and have exceptional time management skills.
• Must possess excellent organizational skills and have strong attention to detail.
• Must be able to maintain confidentiality.
• Various computer skills (Microsoft Word, Excel, etc.), email knowledge, telephone and verbal communication skills are a must.
• Perform other duties as assigned.

• None

• Ability to perform various motor skills such as; standing or sitting for long periods of time, walking, sitting, lifting (up to 25 pounds) using proper lifting techniques, stair climbing, reaching, bending, twisting, pushing, pulling, squatting, grasping and arm-hand coordination on a continuous basis.
• Must be able to see various colors and work closely with computers, at least 8 hours per day.

• None expected

• Must have a minimum of a 2-year college degree, or equivalent experience.

• Provider credentialing experience

Please note this job description is not designed to cover or contain a comprehensive listing of all activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time.

Boone Memorial Hospital, Inc. provides equal employment opportunities to all personnel and applicants for employment and prohibits discrimination, harassment, prejudice, or behavior of any type based on race, color, religion, age, sex (including pregnancy), national origin, disability status, family medical history or genetic information, past or present military service, sexual orientation, gender identity or expression, family or parental status, political affiliation, or any other characteristic protected by federal, state or local laws.