Credentialing Specialist

Overview

At SCA Health, we believe health care is about people – the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the mission, vision and values that define our organization.

As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.

What sets SCA Health apart isn’t just what we do, it’s how we do it. Each decision we make is rooted in seven core values:

• Clinical quality
• Integrity
• Service excellence
• Teamwork
• Accountability
• Continuous improvement
• Inclusion

Our values aren’t empty words – they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.

At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Please visit, to learn more about our benefits.

Your ideas should inspire change. If you join our team, they will.

Responsibilities

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.

• Manage the full cycle of provider credentialing with insurance carriers
• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications and facility privileging
• Maintain credentialing software to ensure all information is accurate and updated
• Update each provider’s CAQH database file timely according to the schedule published by CMS
• Coordinate with practice on the application for and renewal of all provider licenses; Professional, DEA, Controlled Substance, etc.
• Collaborate with practice to obtain all provider data as relates to credentialing and privileging
• Manage revalidation requests issued by government payers
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payers and facilities
• Credential new providers and current providers with facilities at which they hold staff privileges
• Work closely with the CBO and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Maintain updated provider rosters and review biannually with major payers
• Establish and maintain relationships with payers and adhere to all payer credentialing requirements
• Develop and maintain policies and procedures related to credentialing and privileging
• Other duties as assigned

Qualifications

Education Required:

• Minimum of a high school diploma or GED is required
• Undergraduate degree or equivalent experience

Experience Required:

• Minimum of 5+ years’ experience in medical practice business office role including 1-2 years’ experience as a supervisor
• Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
• Highly (above average level) detail oriented with excellent follow through to see tasks to completion
• Excellent computer skills including Excel, Word and Internet / Cloud based technology
• Strong and clear written and verbal communication skills
• Excellent customer service skills
• Possesses a high degree of self-motivation and produces high quality work with minimal supervision

USD $58,240.00/Yr. USD $58,240.00/Yr.

Originally posted on Himalayas