Medical Staff Credentialing Specialist, Sr. processes credentialing and recredentialing applications for health care providers. Mails, reviews, and verifies credentialing applications. Being a Medical Staff Credentialing Specialist, Sr. loads and maintains provider information in an online credentialing database system. Tracks license and certification expirations for medical staff to ensure timely renewals. Additionally, Medical Staff Credentialing Specialist, Sr. handles and resolves inquiries regarding credentialing information, process, or status. May provide guidance or expertise to less experienced specialists. Requires a high school diploma. May require Certified Provider Credentialing Specialist (CPCS). Typically reports to a supervisor. The Medical Staff Credentialing Specialist, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Medical Staff Credentialing Specialist, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)
Location | US-MO-Kansas City | ID | 2024-163738 | Category | Business Professional | Position Type | Full Time | Shift | Days | Job Type | Non-Exempt |
At St. Joseph Medical Group and Kansas City Physician Care, our dedicated team of professionals is committed to our core values of quality, compassion, and community. Affiliated with St. Joseph Medical Center, St. Joseph Medical Group and Kansas City Physician Care are actively seeking new members to join their award-winning teams!
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Responsible for tracking provider enrollments, re-credentialing, and new contract applications with commercial and government health plans. Perform CAQH maintenance. Effectively communicate the contracting and enrollment process, addressing and providing regular updates to Regional Directors. Possess comprehensive knowledge of managed care company and plan requirements. Monitors and maintains websites for pending revalidations and credentialing requests.
EDUCATION, EXPERIENCE, TRAINING
1. Associates degree preferred or equivalent education/experience.
2. Certified Provider Credentialing Specialist (CPCS) preferred
3. Must have strong computer, communication, and writing skills.
4. Must be proficient in Microsoft Office: Word, Excel, and PowerPoint.
5. Must exhibit a positive attitude and willingness to learn. 6. Knowledge of managed care plans, PECOS, NPPES,CAQH
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