Credentialing Specialist

at  My Cloud Crew

JOB DESCRIPTION:

A Credentialing Specialist ensures healthcare providers meet industry standards and legal requirements for practicing medicine. They verify qualifications, licenses, and credentials, ensuring compliance with regulations.
For business owners in healthcare, having a specialist ensures smooth operations, avoids legal issues, and builds trust with patients and insurers. They streamline processes, manage paperwork, and maintain accreditation, crucial for success in a highly regulated industry like healthcare.

Credentialing Specialist DUTIES AND RESPONSIBILITIES

• Verify credentials, licenses, and certifications of healthcare professionals to ensure compliance with legal and organizational standards.
• Maintain accurate and up-to-date credentialing records, ensuring information integrity and accessibility for audits and reviews.
• Facilitate credentialing processes for new hires, including application submission, verification, and approval timelines.
• Collaborate with healthcare providers and external organizations to gather necessary documentation and resolve credentialing issues promptly.
• Monitor and track expirations of credentials to ensure timely renewal and compliance with regulatory requirements.
• Conduct regular audits of credentialing files and processes to identify and address discrepancies or areas for improvement.
• Stay updated on industry regulations and best practices to ensure adherence to evolving standards and requirements.

at least 2 years of relevant experience in the same role. Strong knowledge of health insurance policies, procedures, and regulations. Proficiency in medical billing software and electronic health records (EHR) systems. Excellent attention to detail and organizational skills. Strong communication and interpersonal skills. Ability to maintain confidentiality and handle sensitive information

• Verify credentials, licenses, and certifications of healthcare professionals to ensure compliance with legal and organizational standards.
• Maintain accurate and up-to-date credentialing records, ensuring information integrity and accessibility for audits and reviews.
• Facilitate credentialing processes for new hires, including application submission, verification, and approval timelines.
• Collaborate with healthcare providers and external organizations to gather necessary documentation and resolve credentialing issues promptly.
• Monitor and track expirations of credentials to ensure timely renewal and compliance with regulatory requirements.
• Conduct regular audits of credentialing files and processes to identify and address discrepancies or areas for improvement.
• Stay updated on industry regulations and best practices to ensure adherence to evolving standards and requirements