The Credentialing Specialist is responsible for all aspects of credentialing, re-credentialing and privileging processes for all medical, dental and behavioral health providers. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans for all relevant Jordan Valley locations and local hospitals as appropriate. Maintain up-to-date data for each provider in credentialing databases and online systems; and ensure timely renewal of licenses and certifications.
Associates degree in HR, management, business, social work, or related field.
One to three years experience in medical staff services/work.
Microsoft Office experience.
Excellent organizational, communication and judgment skills.
Insurance credentialing experience.
Bachelor’s Degree in HR, management, business, social work, or related field.
Coordinates all insurance credentialing and privileging for new providers as well as re-credentialing and re-privileging for current providers.
Compiles and maintains current and accurate data for all providers.
Coordinates work with external credentialing agencies.
Monitors the program for compliance with external review agencies and maintains compliance with Federal, State and Local regulatory bodies.
Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
Maintains knowledge of current health plan and agency requirements for credentialing providers.
Sets up and maintains provider information in online credentialing databases and system.
Maintains collaborative practice agreements for medical mid-level providers; updated as necessary and ensuring guidelines are met.
Verifies current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. Maintains copies of primary source verification as required. Tracks license and certification expirations for all providers to ensure timely renewals.
Assists with the on-boarding process of Medical, Dental, and Behavioral Health providers.
Serve as Government and Commercial Insurance Provider Relations liaison. Provide updates as required.
Responds to calls and visits from employees, managers, and others and determines the priority of the situation. Suggests appropriate actions. Answers telephones, prioritizes, screens, and redirects calls. Answers questions, handles routine matters, and takes messages.
Ensure the timely completion and submission of required compliance with all existing governmental and labor reporting requirements.
Follows all organizational and departmental policies and procedures in the performance of all job duties to ensure a safe work environment for self and others.
Promotes effective working relations and work effectively as part of a team to facilitate the Clinic’s ability to meet its goals and objectives.
Attains all agreed to goals and objectives within specified time frames, as part of the Clinic’s overall mission.
Responsibly follows the Clinic Exposure Control Plans/Bloodborne and Airborne Pathogens.
Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to ensure a professional, responsible and courteous environment.
All other duties as assigned.
We offer competitive salary, benefits (including medical, dental, vision), retirement, PTO, and recognize 9 paid holidays.
Jordan Valley Community Health Center is a Federally Qualified Health Center, primarily located in family-friendly Springfield, Missouri. We bring quality professionals and advanced services in one location, committed to improving the health of our community by providing superior and accessible medical, dental, and behavioral health services to Springfield and surrounding communities.