CSS Credentialing Specialist

Overview

Job Description - CSS Credentialing Specialist )

LifePoint Health Support Center

Description

The Credentialing Specialist is responsible for data entering, gathering, and primary source verification of healthcare practitioner information, including in-depth, detailed, or challenging research of information. Primary methods of researching information include phone, fax, e-mail, internet, and letters. This position needs to be knowledgeable in health care, be task oriented, and work with other team members to accurately and timely process documentation as required.

• General Responsibilities:
  • Perform primary (e.g., hospitals, licensing boards, etc.) and secondary source verifications of perspective providers' credentials with special emphasis on provider issues relating to malpractice claims, privileging, criminal concerns, license anomalies and discrepancies in education
  • Responsible for gathering and verifying physician information, compiling required documents, researching necessary information and verifying medical licenses
  • Scrutinize provider applications and resumes for consistency and accuracy
  • Compiles documents, researches and verifies provider backgrounds by contacting hospitals, licensing boards, medical schools, etc.
  • Contacts or interviews provider peer references over the phone about the providers clinical performance skills.
  • A minimum of 0-2 years’ experience in data entry, office administration management or medical financial experience. 0-2 years’ experience in credentialing/licensure verification/checks. Home health experience preferred. Requires excellent analytical skills, flexibility and ability to perform detailed follow through and prioritization.

• Competencies:
  
  To perform the job successfully, an individual will demonstrate the following competencies:
• Analytical - Collects and researches data;
  Uses intuition and experience to compliment data. Possesses a solid attention to detail to ensure accuracy of information
• Customer Service - Responds promptly to customer needs in a professional manner
• Interpersonal Skills - Maintains confidentiality of all patient information and company documents
• Oral Communication – Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions.
• Written Communication – Writes clearly and informatively;
  Edits work for spelling and grammar;
  Presents numerical data effectively;
  Able to read and interpret written information
• Professionalism - Approaches others in a tactful manner;
  Treats others with respect and consideration regardless of their status or position. Maintains positive business relationships.
• Quality - Demonstrates accuracy and thoroughness
• Quantity - Meets performance and / or productivity standards
• Adaptability - Adapts to changes in the work environment
• Attendance/Punctuality - Is consistently at work and on time

• (Experience, Education and Special Certifications…)
• Associate's degree is highly preferred. A combination of education and experience will be considered.
• A minimum of 3 years of credentialing or equivalent work experience is required
• Have clear and concise phone and verbal communication skills ability to write legibly
• Have strong computer, typing, and data entry skills: includes MS Word, Excel and web-based applications, internet, and database programs
• Detail oriented with ability to recognize vital information from verification documents
• Possess proof-reading skills sufficient for auditing documents
• Ability to prioritize well and meet overlapping deadlines
• Demonstrate problem-solving, critical thinking, and deductive reasoning skills
• Ability to consistently maintain quality and production expectations

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requires prolonged sitting and some bending, stooping, and stretching. Requires eye-hand coordination and manual dexterity sufficient…