Job description

Position Summary:

The Credentialing Specialist is responsible for credentialing and recredentialing Millennium’s Practitioners. We are a multi-specialty group with 65 and growing providers, the credentialing specialist will be responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Functions include, but are not limited to, processing credentialing applications, performing primary source verification’s, and implementing and maintaining Millennium’s credentialing database in accordance with internal policies and procedures, client health plan contracts, URAC guidelines and applicable state and federal requirements.

Responsibilities:

· Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for the credential’s verification process

· Responsible for cleaning-up Provider rosters and credentialing Millennium with all Payor’s under a delegation status as opposed to individual enrollment

· Review practitioner applications for completion and accuracy and ensure appropriate follow-up; monitor and report on the credentialing progress of each practitioner

· Responsible for gathering, verifying evaluating highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standards

· Collaborate with our centralized business office patient access team

· Efficiently perform all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner files

· Respond to all practitioner and internal inquiries in a timely manner

· Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the specified timeframe

· Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s)

· Collaborate with leadership team and/or external agencies to facilitate and ensure smooth hand-off during the credentialing process

· Use critical thinking skills to conduct follow-up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process

· Conduct sanctions and compliance monitoring and alert internal team of any undisclosed negative findings immediately

· Responsible for maintaining CAQH, CLIA and OneView by Modio Health data platforms

· Actively participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency

· Other duties as assigned

Educational Requirements:

· Associates or bachelor’s in business, Finance, Health Care or related field or high school diploma and relevant combination of education and experience

Required Skills and Abilities:

· Experience with large physicians’ groups & multimodality ancillaries

· Experience with medical and professional credentialing processes, policies and procedures, including delegated credentialing requirements

· Familiarity with practitioner billing and claims payment system requirements as related to practitioner enrollment

· 3+ years of credentialing experience in a health care setting to include up to two years of practitioner enrollment, credentialing or network services experience

· Demonstrated ability to work independently

· Ability to manage multiple projects efficiently and accurately

· Strong written and verbal communication skills

· Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external clients

· Ability to adapt to change and meet deadlines

· Excellent attention to detail and high degree of accuracy

Preferred:

· Certified Practitioner Credentialing Specialist (CPCS)

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Kingwood, TX 77339: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• What credentialing platforms do you have access to?

License/Certification:

• Certified Provider Credentialing Specialist (Preferred)

Work Location: One location

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