Credentialing Specialist Full Time
From our Dallas corporate headquarters to our clinics and worksite locations, Concentra colleagues remain focused on our driving purpose: to provide superb patient and employer experience by delivering the highest quality healthcare in an efficient, affordable, caring manner. We do this by putting all customers (internal and external) first and by displaying:
- A healing focus
- A selfless heart
- A tireless resolve
Will perform all functions in support of initial credentialing, recredentialing, and credentialing monitoring requirements including, but not limited to, performing a comprehensive quality review of “non-standard” credentialing/re-credentialing, which includes those files with questionable clinical, quality and/or business issues, provider license monitoring, updates to credentialing database from internal reports and notifications, initiation of CAQH application process for initial credentialing, initiation of recredentialing process, and facilitation of CAQH reattestations. Additionally, this position is responsible for assisting with the routing of files to and from the medical advisor and to and from the credentialing committee.
- Review applications and documentation submitted for completeness and appropriate signatures and dates.
- Generate necessary correspondence (i.e. request for missing information letters, explanation of discrepancy letters, welcome/continued participation letters).
- Appropriately identify and forward applicant files which do not meet “standard” requirements to medical advisor and/or credentialing committee, according to established guidelines.
- Obtain additional information regarding discrepancies and/or adverse actions.
- Primary Source Verification of initial credentialing/re-credentialing files according to NCQA Standards.
- Participate in credentialing committee meetings to assure committee members have necessary information, explain questionable information contained in file and act as overall resource for general credentialing processes.
- Conduct license monitoring process for all providers in accordance with license monitoring policy, to include initiation of letters, reports, and primary source verification of renewals.
- Update Credentialing database (IntelliCred) as appropriate from internal reports and notifications.
- Facilitate creation and/or updating of CAQH applications for initial credentialing and recredentialing.
- Facilitate provider reattestations of CAQH data as required by CAQH.
- Works with External Payer Credentialing and Medicare Enrollment teams on various credentialing products.
- Ability to adapt to change/remain flexible, meet expected deadlines and act as a team player.
- Ability to think and act independently using individual discretion relative to credentialing file review, verification and reporting.
- Effectively communicate updates, ideas and concerns to Management regarding credentialing/re-credentialing activities.
- Will make decisions regarding the data integrity of an applicant’s initial or re-credentialing information as it appears in our provider database based on the guidelines set by Concentra.
- Obtain credentialing documents, expired since verification process was complete.
- Entry and maintenance of clinician credentialing information into credentialing database.
- Maintain knowledge of state credentialing regulatory requirements, accrediting body requirements and Concentra standards to assure compliance and/or recognize possible compliance issues.
- College degree preferred
- CPCS certification preferred
- Minimum 1-2 years direct experience in credentialing required
- Certified Professional Credentialing Specialist certification preferred
- Knowledge of credentialing software (IntelliCred) is preferred
- Working knowledge of NCQA, URAC and/or AAHC credentialing standards
- Ability to work independently within guidelines and company policies
- Working knowledge of credentialing processes, procedures and systems.
- Working knowledge of computer software applications such as word processing and spreadsheets
- Ability to effectively present information and respond to questions from managers, clients, and internal and external customers
- Must have ability to work in fast paced environment
- Must be very detail-oriented
- Must be able to make independent decisions when issues arise and upper management is not available.
- Must be able to multitask and prioritize effectively.
- 401(k) with Employer Match
- Medical/Vision/Prescription/Dental Plans
- Life Insurance/Disability
- Paid Time Off/Holidays
- Colleague Referral Bonus Program
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Concentra is an Equal Opportunity Employer, M/F/Disability/Veteran.