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Credentialing Specialist


Job Location: Wichita, Kansas
Hours: 8-5


Position Title: Credentialing Specialist

Reports To: Credentialing Supervisor

SUMMARY DESCRIPTION:

The Credentialing Specialist is responsible for WPPA Provider credentialing and primary source verification, maintaining Provider licensure, collaboration agreements, medical malpractice insurance and certifications, assisting with credential committee meetings, CAQH, and Provider terminations.

DUTIES AND RESPONSIBILITIES:
· Processing and maintaining of new Providers according to WPPA Credentialing Policy;
· Process, communicate, and maintain Provider background checks, primary and secondary source verifications, medical licenses, and certifications to team;
· Create and maintain Provider electronic data files including licensure, certificate, and other required retention documents;
· Responsible for Provider and CAQH rosters, profiles, re-attestations, terminations, and uploading to credentialing software;
· Responsible for new Provider onboarding, credentialing packet delivery, return, and distribution to team;
· Responsible for communicating Provider sanction notifications;
· Maintain the credentialing database tracking Provider licensure;
· Request, maintain, and terminate Provider malpractice insurance via insurance carrier and database;
· Coordinate and process Provider re-credentialing per WPPA Credentialing policy;
· Back-up chairperson for Provider Membership Committee, as needed;
· Communicate and responsible for Provider licensure, certification, and collaborating agreement expirables to Provider, Practice Managers, and management team;
· Maintain strict confidentiality of Provider, company, and personnel information; and
· Other roles and duties may pertain as needed.

EDUCATION AND EXPERIENCE:

· Associate’s degree preferred; or any combination of education and experience, which would provide the required knowledge, skills and abilities may be qualifying.
· One or more years, experience working in a managed care, hospital, or medical office environment preferred.
· One or more years of credentialing experience preferred.
· Preferred experience with primary source verification and associated credentialing processes.

JOB SPECIFIC KNOWLEDGE, SKILLS AND ABILITIES:

· Working knowledge of and skill in operating standard office equipment, such as computer, fax and copier;
· Ability to use Microsoft Office applications, including Word and Excel;
· Ability to use Adobe Acrobat or similar applications;
· Ability to interpret policies, standards and guidelines;
· Ability to research and maintain multi-state primary source verification and ongoing monitoring;
· Clear understanding of Provider malpractice insurance state requirements;
· Strong attention to detail, accountability, organizational, and interpersonal skills;
· Ability to multi-task and work independently;
· Ability to work in fast paced environment and prioritize duties; and
· Strong accountability to team environment.

REQUIRED STANDARD KNOWLEDGE, SKILLS AND ABILITIES:

· Ability to communicate effectively, both orally and in writing;
· Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position;
· Ability to prioritize tasks and meet deadlines; and
· Ability to maintain confidentiality.

HOURS:
8:00AM-5:00PM Monday-Friday

SALARY:
$13.00 to $15.00 /hour


How To Apply:
Please submit your resume to:

ProviDRs Care
Justin Leitzen
1102 S. Hillside
Wichita, KS 67211



 

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