External Credentialing Specialist at All Star Recruiting Locums LLC

Boca Raton, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

30 Jun, 26

Salary

0.0

Posted On

01 Apr, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing, Organizational Skills, Attention to Detail, Communication, Research Skills, Database Management, Managed Care, Microsoft Office, Healthcare Knowledge, Licensing, Auditing, Problem Solving, Interpersonal Skills, Regulatory Compliance, Data Entry, Follow-Up

Industry

Staffing and Recruiting

Description

All Star Healthcare Solutions is looking for dedicated, energetic, hardworking individuals who want to join a very successful and growing healthcare staffing company in the North Broward area. Our culture is professional, fast-paced, and people-centric. Our team members provide exceptional service in a people-first environment. We pride ourselves on effectively servicing our Providers, Clients, and the Community; while also focusing on our employees' personal, professional, and financial goals. As a Sun-Sentinel Top Places to Work recipient, All Star is the team to join if you are looking for specialized development, benefits, competitive pay, and job expansion, in a fun and collaborative environment. Job Summary: The External Credentialing Specialist will be responsible for maintaining the credentialing and re-credentialing process for All Star Recruiting healthcare providers. Additionally, the External Credentialing Specialist will contact Medical Staff Offices and facility Payor Enrollment contacts as needed to complete all facility credentialing requirements, as well as communicate with healthcare personnel to maintain up-to-date files on physicians, and NP/PAs. The Credentialing Specialist is also responsible for answering inquiries regarding providers' credential status and working with the locums division to ensure the accuracy of all files by tracking the expiration of licenses and certifications. In addition, the External Credentialing Specialist will act within the values of All Star Healthcare Solutions. Supervisory Responsibilities: • None Duties/Responsibilities: • Coordinates and monitors the review and analysis of Physicians and Allied Professionals applications and accompanying documents, ensuring applicant eligibility • Compiles and maintains current and accurate data for all providers • Conduct thorough research and primary source verification of all components of the application file • Identify issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up • Processes and completes provider credentialing and re-credentialing applications; monitors applications and follows-up as necessary • Sets up and maintains provider information in company databases • Process applications for appointment and reappointment of privileges • Tracks licenses, DEA certificates and professional liability expirations and any other required credentialing document for appointed providers • Handles telephone calls and assists callers by conveying their issues to the appropriate individual or department and performing follow-up, as required • Maintains knowledge of jurisdictional requirements and document credentialing changes as needed. • Audit health plan directories for current and accurate provider information • Assists with internal file audits • Participates in the development of and adherence to department rules and regulations; and policies pertaining to medical staff, practitioner/provider, and the organization • Utilizes credentialing databases, optimizing efficiency, and performs query, reports, and document generation; submits and retrieves National Practitioner Data Bank reports in accordance with Health Care Quality Improvement Act • Communicates credentialing requirements and documents as needed • Other duties as assigned Knowledge, Skills/Abilities: • Professional, motivated, with pleasant demeanor • Excellent organizational and follow- up skills • Strong attention to detail • Ability to communicate effectively, both orally and in writing • Informational research skills • Database management skills including querying, reporting, and document generation • Knowledge and understanding of the credentialing process • Ability to organize and prioritize work and manage multiple priorities • Ability to work with general supervision • Knowledge of related accreditation and certification requirements and standards • Working knowledge of clinical and/or hospital operations and procedures • Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization • Displays knowledge of key functions, terminology, and work products of legal, information technology, risk management and performance concepts Education and Experience: • High school diploma or equivalent required (Bachelor’s Degree Preferred) • Minimum one (1) year of experience in provider credentialing or in health care industry preferred • Knowledge in managed care/insurance credentialing a plus • Proficient use of Microsoft Office applications (Word, Excel, Outlook) and internet resources • Any combination of knowledge, skills, abilities, experience and/or education may be considered Physical Requirements: • Prolonged periods of sitting at a desk and working on a computer. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. All Star Healthcare Solutions reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. This job description is NOT a contract for employment and does not modify or circumvent the employee’s ‘at-will’ employment relationship with the company. All Star Recruiting Locums, LLC and affiliates are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity, age or any other category protected by law

Responsibilities

The External Credentialing Specialist is responsible for maintaining the credentialing and re-credentialing process for healthcare providers and ensuring compliance with facility credentialing requirements. This includes monitoring applications, tracking licenses, and communicating with healthcare personnel.