Healthcare Credentialing Specialist

Job Description

The Credentialing Specialist ensures all clinicians are credentialed with the Oklahoma Health Care Authority, Medicare, and other Private Insurance Companies.

Assist in keeping Red Rock’s credentialing database maintained, and ensures electronic files are up to date.

Essential Functions
Maintains high quality, timely and accurate credentialing processes of healthcare clinicians and continues to build excellent rapport with clinicians and insurance companies
Assists in the credentialing process by entering/logging/scanning information into the credentialing system for initial, updating, and add on applications and maintenance process
Processes and maintains credentialing and re-credentialing in accordance with client facility policy and procedure, Commission on Accreditation of Rehabilitation Facilities (CARF) standards, State and Federal Regulatory regulations
Monitors collection of all information received; follows up on missing items and/or incomplete forms, submits follow up requests for verifications as needed
Identifies and evaluates potential red flags and works in collaboration with clinician to document the issue and healthcare provider responses
Advises Credentialing Supervisor of questionable information received and any issues identified during the processes
Maintains all credentialing files ensuring that all correspondence in the credentialing and reappointment process is accurately electronically filed; keeps current process and legal/regulatory requirements
Performs other duties as assigned
Qualifications
High School Diploma or equivalent; Associates preferred
Minimum one-year experience preferred in healthcare credentialing (i.e., healthcare facility, managed care facility, credentials verification organization, or Medical Staff Office)Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred
Strong problem solving skills, good judgment, attention to detail and follow-through
Experience working with the Oklahoma Health Care Authority is a plus
Ability to maintain confidentiality of privileged information Ability to work independently, productively and well under pressure
Working knowledge of the healthcare and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards preferred
Commitment to the mission of Red Rock BHS
Benefits
Employee Health Insurance for as low as $10 per month
Dental Insurance
Vision Insurance
403B Retirement plan with employer contribution
Professional Growth funds
Paid Time-off
Employer paid long term disability
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

We are an equal opportunity employer and do not discriminate on the basis of race, color, religion (creed), gender, age, national origin (ancestry), disability, marital status, sexual orientation, military status, or any other basis made unlawful by applicable federal, state, or local laws or regulations.

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