Credentialing Specialist

STS Federal - Oviedo, FL

CREDENTIALING SPECIALIST

 

POSITION QUALIFICATION/REQUIREMENTS:

  • High School Diploma (preferably Associates degree)
  • Experience with medical and professional credentialing processes, policies, and procedures, including delegated credentialing requirements.
  • Minimum of 1 year of credentialing experience in a health care setting with prior experience with practitioner enrollment, credentialing, or network services experience. (Preferably experience with military contracting)
  • Requires exceptional critical thinking skills, sound judgment and the ability to communicate in an articulate and sensitive manner with practitioners, healthcare workers, administrators, and client credentialing personnel.
  • Experience with Microsoft Office, Excel, internet search tools, and research techniques

CORE DUTIES:

  • Perform the initial credentialing and re credentialing functions for all levels of healthcare workers
  • Maintain timely and accurate data entry and periodically revise practitioner data in the credentialing database; maintain practitioner paper and electronic data files for practitioners within company databases and with company approved naming conventions
  • Track candidates steps through the Credentialing process and provide metrics
  • Monitor expiring licensure, board, and professional certifications and other expirable documents with practitioners within the prescribed time frames as outlined in the policies and procedures, assisting practitioners with timely renewal as appropriate and escalating to manager and field management as appropriate.
  • Lead Joint Commission Accreditation (JCA) process and maintain JCA standards going forward.
  • Conduct sanctions and compliance monitoring and alert Management of any undisclosed negative findings immediately.
  • Assist healthcare workers when needed, in a timely fashion, to ensure goals are achieved per contract
  • Monitor and report progress of each healthcare worker
  • Adhere to policies and procedures including timely delivery of completed work and use of resources.
  • Identify, analyze, and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners and ultimately bill and obtain reimbursement for services rendered; discover and convey problems to Manager
  • Manage and coordinate all background checks and any required registration
  • Perform all other duties as assigned to assist in the success of the credentialing team.

HOURS:

  • The normal hours are from 8:30am to 5:00pm Monday - Friday.

 

SPECIAL REQUIREMENTS/SKILLS: Must be comfortable in a fast-paced, dynamic environment. Must be able and willing to reprioritize on short notice and work on multiple simultaneous projects. Flexible and able to work with various personalities. Teamwork skills required. Time management skills required. The ability to meet deadlines in a deadline intensive environment is essential. High level of adaptability and willingness to embrace change in a fast-paced, demanding environment.

COVID VACCINATION:

  • Must be FULLY vaccinated for COVID-19.

STS Federal, LLC. is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.



Posted On: Monday, August 30, 2021



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