Credentialing Specialist-Managed Care
Full-Time, 80 Hours Per Pay Period
Position Summary: This position is responsible for prioritizing and managing tasks in the Managed Care department in regards to Payer Enrollment and Hospital credentialing. With limited supervision, the Credentialing Specialist acts as a liaison among Covenant Medical Group (CMG) office managers, Medical Staff coordinators, and hospital administration. The specialist may do any of the following: process payer enrollment, facility credentialing, pro-fee enrollment, expirables, hospital credentialing / re-credentialing applications for CMG Providers, Medical Staff members and advanced practice professionals, and maintains credentialing database. Enrolls new CMG and Pro-fee providers with Payers; send out and process initial hospital applications; performs verification of payer enrollment and reappointment applications by preparing requests for information; tracks responses and follow up on requested information. Assists the Manager, System CVO Operations as requested, and attends meetings as needed. Specialists will be expected to cross-train in all above areas for department efficiency.
Minimum Education: None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to an Associate’s degree.
Minimum Experience: Minimum of two (2) years’ experience in Payer enrollment or hospital credentialing; knowledgeable with Joint Commission and NCQA credentialing standards; experience with Visual Cactus preferred; good organizational, data entry, and communication skills.
Licensure Requirement: None
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