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Credentialing Specialist

1 month ago

Makati City, National Capital Region, Philippines Epic Healthcare Staffing Shared Services, Inc. Full time

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The Credentialing Specialist is responsible for all aspects of initial credentialing, recredentialing, and if applicable privileging of clinicians and/or providers within credentialing scope who are employed or contracted to provide care to our healthcare and education customers throughout the US.

Potential Start Date: April 15, 2025

Qualifications:

  • High school diploma or equivalent education.
  • Preferred at least 1-2 years of experience in education or healthcare staffing credentialing.
  • Certified Provider Credentialing Specialist (CPCS) can substitute for experience.

Knowledge, Skills and Abilities:

  • Professional & Technical Expertise: Possess an overall knowledge of business functions and understanding of services, business strategy, policies and procedures, and job's impact to the organization.
  • Fact Finding: Obtain facts and data pertaining to an issue or question.
  • Decision Making: Make quality decisions and meet timeliness of those decisions.
  • Legal & Regulatory Navigation: Understand, interpret, and ensure compliance with laws and regulations.
  • Integrity & Ethics: Maintain trust through honesty, adherence to principles, and personal accountability.
  • Self-Management: Analyze work, set goals, develop plans of action, utilize time.
  • Oral Communication: Engage effectively in dialogue.

Major Duties and Responsibilities:

  • Perform all aspects of initial credentialing, recredentialing, and/or privileging, for the providers and/or clinical teams throughout the US.
  • Collect and verify sensitive provider and/or clinician data through confidential sources; manage, upload, and maintain compliance documents in required systems; regularly review reports to monitor completion of applications.
  • Assess, evaluate, and interpret application and verification information to identify 'red flags' or areas of established non-compliance; communicate adverse, incomplete, or questionable data to appropriate parties and recommend appropriate course of action.
  • Manage incoming and outgoing communications between multiple parties while meeting policy timelines and updating the credentialing database; provide status reports and communicate provider and/or clinician participation information to internal and external customers.
  • Provide written and verbal communication with federal, state, and local agencies, hospitals, medical review boards, educator review boards, and malpractice carriers to obtain provider and practitioner information.
  • Participate in preparation for Internal and external audits conducted for current and accurate provider and/or clinician information or delegation compliance; audit files based on internal standards and regulatory / accreditation requirements (e.g., CMS, DSHS, NCQA & JCAHO, DNV), if applicable.
  • Assist providers and/or clinicians with setting up appointments (e.g., physicals, drug screens, PPDs, Chest X-rays, titers, vaccinations, fit tests, color tests, etc.).
  • Maintain positive relationships, written and verbal communication, and high levels of both internal and external customer service with customers, vendors, employees, and other parties related to company's credentialing efforts.
  • Remain current with the research, review and interpretation of applicable accreditation, licensing, and other regulatory requirements to ensure credentialing policies and policies continually meet requirements.
  • Participate in design and development of forms, workflows, processes, etc., to support credentialing processes.
  • Maintain documentation of credentialing activities, such as feedback received from fellow colleagues and review and escalate when needed.

Other Duties

  • This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job and may vary based on the needs of the Strategic Business Unit (SBU).
  • This job description does not include performance metrics, which may vary by position.

What's in store for you at Epic?

  • Competitive salary package, quarterly performance bonus
  • HMO (medical and dental) & Life Insurance coverage
  • Paid vacation and sick leave credits. All unused leave credits are convertible to cash by end of the year
  • Additional Covid-19 vaccine and birthday leave credits
  • Extra allowances will be given for WFH set-up such as internet subsidy and transportation allowance for WFO set-up
  • Medicine & Optical reimbursements
  • Perfect Attendance bonus
  • Career development and advancement opportunities
Seniority level
  • Mid-Senior level
Employment type
  • Full-time
Job function
  • Other
Industries
  • Health and Human Services
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