Credentialing and Licensing Specialist III

Job Description Summary

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The Credentialing Licensing Specialist is responsible for enrolling and/or updating all providers with contracted insurance carriers. S/he also assists in staff privileges at area hospitals and nursing homes. S/he maintains current accurate information for the physicians and mid-level providers in MPG’s database, with insurance carriers, and facilities. These goals are met in a timely manner consistently and effectively. s/he will assist the Business Services teams as necessary. Additional duties as assigned.

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How will you make an impact & Requirements

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Responsible for new and existing applications and reappointment paperwork is complete, accurate and timely including tasks required for exiting providers.

Collects and processes verification and accreditation information for all physicians and mid-level providers associated with insurance carriers.

Supports physician and mid-level providers as needed for licensure renewals.

Maintain professional and open communication with physicians, mid-level providers and individuals within MPG to ensure up to date and consistent record keeping.  Ensures all provider files are current with Human Resources.

Demonstrates proficiency in Microsoft Word, Excel, and software unique to credentialing (i.e. , Verity, Intellisoft or hospital on-line application processes).

Use Athena as needed to fulfill job responsibilities and/or other associated assignments.

Keeps supervisor fully informed regarding job responsibilities and challenges to success.

Demonstrate excellent interpersonal and communication skills.