Provider Credentialing Specialist (Hybrid)
Do you want to use your problem solving skills and knowledge of credentialing to help improve the health of America's workforce? At Concentra, we serve more than 500 medical centers and 130 onsite clinics nationwide. Concentra colleagues remain fueled by our driving purpose: to provide outstanding patient experience by delivering the highest quality healthcare in an efficient, affordable, and caring manner. We do this by putting all customers first.
At Concentra, our Internal Credentialing Specialist is responsible to perform all functions in support of initial credentialing, recredentialing, and credentialing monitoring requirements. This will include, but not limited to, performing a comprehensive quality review of “non-standard” credentialing/re-credentialing. Review of files with questionable clinical, quality and/or business issues, provider license monitoring, updates to credentialing database from internal reports and notifications, and initiation of CAQH application process for initial credentialing, initiation of recredentialing process. 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.
- 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.
- Enter and maintain clinician demographic and credentialing information in credentialing database (IntelliCred) obtained through credentialing application, primary source verifications, internal reports and notifications.
- Facilitate creation and/or updating of CAQH applications for initial credentialing and recredentialing.
- Works with External Payer Credentialing and Medicare Enrollment teams on various credentialing products.
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice
- High School Diploma or GED
- Customarily has at least one or more years of related experience, or equivalent combination of education and experience
- Knowledge of credentialing software (IntelliCred) is preferred
- Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility
- Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions
- Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism
- The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies
- Ability to adapt to change/remain flexible, meet expected deadlines and act as a team player
- Computer skills to include Word, Excel, Power Point, some Access, Outlook (or similar email program) and ability to learn and utilize all proprietary Concentra software programs
- Basic familiarity of credentialing as defined by legislative/regulatory or state bodies
- Interpersonal and communication skills, both written and oral, with varying levels of colleagues and/or management
- Adapts to change and remains flexible, meets expected deadlines and acts as a team player
- Ability to manage open projects to the end with successful follow up
- Attention to detail and strong organization skills.
- Ability to work independently within guidelines and company policies
- 401(k) Retirement Plan with Employer Match
- Medical, Vision, Prescription, Telehealth, & Dental Plans
- Life & Disability Insurance
- Paid Time Off & Extended Illness Days Offered
- Colleague Referral Bonus Program
- Tuition Reimbursement
- Commuter Benefits
- Dependent Care Spending Account
- Employee Discounts
This job requires access to confidential and critical information, requiring ongoing discretion and secure information management.
We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.
CONCENTRA IS AN EQUAL OPPORTUNITY EMPLOYER, INCLUDING DISABILITY/VETERANS