Credentialing Specialist

Overview:
CEENTA is looking to add a Credentialing Specialist to our growing business office team! This position will be responsible for verifying professional credentials for our physicians and providers across our locations. You will have the opportunity to interact with our Operations Managers and providers on a regular basis to ensure that we remain in compliance with all regulatory standards. The ideal candidate will have at least two (2) years of prior credentialing experience.

Primary objective:
This position is responsible for verifying professional credentials and processing the information in compliance with all regulatory standards by performing duties within the scope of the policy and procedures defined by Charlotte Eye Ear Nose and Throat Associates.

Essential functions:
• Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications
• Maintain accurate provider profiles on CAQH, NPPES and CMS databases
• Complete credentialing applications to add providers to commercial payers, CMS and Medicaid
• Complete re-credentialing requests issued by government and commercial payers
• Verify and maintain provider hospital privileges within CredentialStream
• Ensures all individual provider locations within the practitioner database match the CEENTA location reports
• Work closely with the Business Office to identify and resolve any denials or authorization issues related to credentialing
• Maintain the provider flu and PPD grids and forward to appropriate staff
• Update and/or provide verification of all payer directories via electronic submission, email (spreadsheets) and/or phone
• Provides profile updates/verifications for active and termed CEENTA providers to various facilities
• Maintain and submit monthly credentialing allocation reports
• Other responsibilities may be assigned by the Credentialing Manager
• Ability to meet the physical and mental demands of the position
• The ability to work on-site.
• Predictable, reliable, and prompt attendance

Skills and abilities:
• Extremely high level of attention to detail
• Ability to follow procedures and processes in accordance with CEENTA standards and CMS guidelines
• Proficient in Microsoft applications including Excel, Word and Outlook / Office365 required
• Maintain proficiency with office equipment utilized to perform duties which includes dual monitors, printers, and OnBase faxing program
• The ability to multi-task and prioritize work is required

Core competencies:
• High level of attention to detail
• Building trust
• Communication
• Follow-up
• Professionalism

Clinical competencies:
N/A

Training period:
30-90 days

Accountability:
Our mission is to be the premier eye, ear, nose, and throat group providing comprehensive, quality, and ethical healthcare to all in the Carolinas; to provide a favorable environment for the delivery of healthcare; and to provide for the wellbeing of the physicians and the employees of Charlotte Eye Ear Nose & Throat Associates, P.A.

The selected candidate must be reliable and dependable.

Education:
High School diploma or general education degree (GED)

Experience:
• 2 years’ medical staff credentialing experience required
• 2 years’ experience in a medical practice business office role preferred
• Experience with credentialing software packages, NPPES, PECOS and CAQH enrollment

Certificates, Licenses, Registrations:
NAMSS CPSC Certification preferred, not required

Work environment:
The work environment characteristics described are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory responsibilities:
This position has no supervisory responsibilities

Position type and expected hours of work:
Full-time. Standard hours of operation (and working hours): 8am-5pm, Monday-Friday. Additional evening/weekend hours may be required to complete system updates.

This position sits on-site.

Physical, mental, other requirements:
• The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job
• Requires sitting for long periods of time with repetitive movements, such as typing
• Sitting at least 90% of the time
• Must be able to work independently and in a group setting
• Requires a high level of attention to detail

Other requirements:
• Active & Current Driver’s license
• Clean driving record
• Consistent and Reliable Transportation
• Polite and professional disposition

Travel:
Less than 10% travel

Other duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. In addition to those essential functions identified above, individuals in this position are also responsible for performing other duties or tasks that may be assigned. CEENTA retains the discretion to add or change the essential job functions of this position at any time without notice.

A Typical Day in the Position:
90% of the work will be performed on a computer with dual monitors. This position is responsible for answering incoming calls, processing incoming correspondence and updating provider demographics into the credentialing database, as well as other pertinent information. Daily interaction with providers and practice managers. This position is also responsible for data entry of credentialing and insurance information, responding to credentialing inquiries, and retrieving/sending faxes as part of their daily responsibilities.

Equal Employment Opportunity Statement
The Company bases all applicant and employee employment decisions without regard to race, creed, color, religion, age, gender identity or expression, sexual orientation, pregnancy, genetic information, national origin, sex, uniform service, veteran status, protected disability, and any other category protected under federal or state law. This policy of equal employment opportunity applies to all policies and procedures relating to employment including, but not limited to recruitment, placement, employee training and development, promotion, benefits, compensation, leaves of absence, position elimination, layoff, recall, termination, and all other terms and conditions of employment. The Company opposes racial injustice and racial inequality. We strive to provide a diverse workplace wherever employee’s background and experiences are important and bring value to us as an organization. Employees should bring any violations of this policy to the attention of Human Resources.

The South Carolina Pregnancy Accommodation Act protects individuals from employment discrimination for medical needs arising from pregnancy, childbirth or related medical conditions. The Act, which amended the South Carolina Human Affairs Law, also requires that employers provide reasonable accommodations for medical needs arising from pregnancy, childbirth or related medical conditions. Should you have any questions, please contact Human Resources.

Accessibility Accommodation Statement Charlotte Eye, Ear, Nose and Throat Associates is committed to complying with all applicable provisions of the Americans with Disabilities Act, as amended (“ADA”), and applicable state and local laws. It is the Company’s policy not to discriminate against any qualified employee or applicant with regard to any terms or conditions of employment on the basis of such an individual’s disability. If you are an applicant and need a reasonable accommodation when applying for job opportunities within the Company or request a reasonable accommodation to utilize the Company’s online employment application, please contact [email protected].