Job Description

Job Description

Job Description

We are looking for a meticulous and detail-oriented Credentialing Specialist to join a client in Kansas City, Missouri. In this role, you will oversee the credentialing and privileging processes to ensure compliance with established standards and regulations. This Contract-to-Permanent position offers an opportunity to contribute to the quality of a community-focused healthcare organization.

Responsibilities:

• Develops and implements centralized credentialing and privileging processes and procedures for Swope practitioners and maintains confidential credentialing files.
• Prepares credentialing and privileging documents for all initial appointments and reappointments in a timely and complete manner for presentation to the Board of Directors.
• Works closely with physicians, mid-levels, licensed independent practitioners and other licensed or certified practitioners and professional staff to acquire necessary materials and information for enrollment with commercial insurance plans.
• Ensures compliance with HRSA, JCAHO and other grant makers or certification standards for credentialing and privileging of various practitioner types.
• Maintains and/or acquires delegated credentialing as appropriate to benefit Swope Health. 
• Uses credentialing software proficiently and adds credentialing information to the HR associate record as necessary.
• Coordinates with various departments to ensure communication of completed credentialing and privileging requirements to ensure appropriate billing for services.
• Convenes monthly Credentialing Committee meetings, prepares agenda and records, and ensures the decisions of the committee are acted upon. Attends Board meetings as required.
• Coordinate with the HR Talent Acquisition team on new hire credentialing and provider enrollment.
• Ensure team members follow best practices and maintain service level agreements
• Monitors/resolve team issues and associate concerns
• Suggest or innovate on processes as deemed appropriate
• Exercises confidentiality with regard to all information, results, data and other sensitive material.

• Proven experience in credentialing, with knowledge of credentialing processes and standards.
• Familiarity with provider and physician credentialing procedures.
• Strong organizational skills and attention to detail.
• Ability to manage and prioritize multiple tasks effectively.
• Excellent communication and interpersonal skills for working with providers and regulatory bodies.
• Proficiency in maintaining accurate and detailed documentation.
• Experience with re-credentialing applications and processes.
• Knowledge of standards set by accrediting organizations such as the Joint Commission.

Job Tags

Permanent employment, Contract work,

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