The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare, and Medicaid. Ensures providers are licensed and certified as mandated by state and federal regulations. Processes applications for individual and facility credentialing and re-credentialing with carriers. Maintain databases (including One App Database & CAQH) regarding provider training, licenses, education, and relevant job experience. Apply for initial and renewal CLIA Certificates for all entities. Complete malpractice coverage applications and renewals.
DUTIES AND RESPONSIBILITIES:
· Maintains compliance with all regulatory and accrediting institutions
· Monitors provider credentials and licenses
· Advises providers on renewal procedures
· Participates in the development of internal credentialing processes
· Keeps records of licenses, credentials and insurance contracts
KNOWLEDGE, SKILLS, AND ABILITIES:
· Ability to communicate effectively, both orally and in writing
· Program planning and implementation skills
· Knowledge of related accreditation and certification requirements
· Knowledge of medical credentialing and privileging procedures and standards
· Working knowledge of clinical and/or hospital operations and procedures
· Database management skills
· Ability to make administrative/procedural decisions and judgements
· Review carrier newsletters and shares pertinent updates with the Director of Billing
· Associate degree or equivalent in medical terminology, health information management, healthcare administration or a related field
· A few years of experience performing similar duties in a medical facility
TYPICAL PHYSICAL DEMANDS:
· Talk and hear
· Stand, walk, use hands and fingers to handle or feel, reach with hands and arms
· Sit, climb, balance, stood, kneel, crouch, or crawl
· Lift and move up to 10 pounds
· Close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus
Telecommuting is allowed.
Internal Number: 1
About Claris Vision
Eye Health Vision Centers, a Claris Vision Company are your South Coast vision correction experts. We have been proudly providing the Dartmouth, Fairhaven, Fall River, Taunton MA and Middletown RI communities with advanced technology and eye care services for over four decades. Our caring and passionate staff of board-certified ophthalmologists and optometrists are proud to offer LASIK, cataract surgery, dry eye management, glaucoma treatment, aesthetic procedures, and more. Each of our state-of-the-art facilities is equipped with the most advanced technology and diagnostic techniques, as well as a full-service optical office. Our optical teams work closely with our ophthalmologists and optometrists to ensure your vision care needs are met and exceed your expectations. We offer the latest digital lens offerings and the most advanced lens treatments available in the industry. We also have a wide selection of frames, both popular and less-known brands.
At Eye Health Vision Centers, we know that comfort, compassion, and efficiency are integral to a patient’s decision to attend regular eye health appointments. That is why we always strive to deliver the highest quality care, includi...ng patient education and customer service, to each and every patient. Our most important goal is always to improve our patients’ quality of life through better vision and eye health. Contact an Eye Health Vision Centers near you to find out for yourself how we can help you achieve your clearest vision and best eye health.