Credentialing & Privileging Specialist

SUMMARY:  Responsible for all aspects of the Credentialing, Re-credentialing and Privileging processes for all Medical Providers/Medical Personnel who provide patient care at Alabama Regional Medical Services.  Responsible for ensuring providers are credentialed, appointed, and privileged with health plans.  Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

ESSENTAIL DUTIES AND RESPONSIBILITIES:

1.      Compile and maintain current and accurate data for all providers and medical personnel.

2.      Complete provider credentialing and re-credentialing applications, rosters and documents; monitors documents and follow-up as needed.

3.      Maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.

4.      Maintain knowledge of current health plan and agency requirements for credentialing providers.

5.      Set up and maintain provider information in online credentialing databases and systems.

6.      Tracks license and certification expirations for all providers/medical personnel to ensure timely renewals.

7.      Process applications for appointment and reappointment of privileges to Alabama Regional Medical Services

8.      Track license, DEA and professional liability expirations for appointed ARMS providers.

9.      Audit health plan directories for current and accurate provider information.

10.  Maintain confidentiality of provider information.

11.  Provide credentialing and privileging verifications.

12.  Perform other duties as assigned.

QUALIFICATION REQURIEMENTS:

High School diploma or equivalent.

Associate degree preferred.

Certification/Licensure:  Certified Provider Credentialing Specialist (CPCS) preferred.

Minimum of two years of relevant credentialing experience.

EDUCATION AND EXPERIENCE:

Associate's Degree in Health/Human Services or related field, preferred

Certified Provider Credentialing Specialist, preferred

2+years’ experience in Credentialing/ Privileging 

OTHER SKILLS AND ABILITIES:

Knowledge and understanding of the credentialing process.

Ability to organize and prioritize work and manage multiple priorities. 

Excellent verbal and written communication skills including, letters, memos and emails.

Excellent attention to detail.

Ability to research and analyze data

Ability to work independently with minimal supervision.

Ability to establish and maintain effective working relationships with providers/medical personnel.

Proficient use of Microsoft Office applications (Word, Excel, Access)