Credentialing Specialist-Full Time-Days

Facility

Cape Fear Valley Medical Center

Location

Fayetteville, North Carolina

Department

Physician Financial Services

Job Family

Clerical

Work Shift

Days (United States of America)

Summary

Develop and maintain an effectively functional fully integrated credentialing process by working with physicians, third party payors and managed care companies to obtain provider numbers in a timely manner.

Major Job Functions

The following is a summary of the major essential functions of this job.  The incumbent may perform other duties, both major and minor, that are not mentioned below.  In addition, specific functions may change from time to time:

• Develops and maintains credentialing files on physicians with current updated information for use in credentialing process

• Works directly with physicians to verify the accuracy of the credentialing information

• Provides updated information and progress on timely basis to Physician Billing Department, Physician and Business Development Department

• Coordinates the credentialing process with the electronic billing third party payors

• Meets with new physicians prior to start date to discuss credentialing and obtains signatures necessary to complete manage care applications

• Works closely with provider representatives at managed care companies to provide additional information needed to complete credentialing process

• Complete and process re-credentialing applications for physicians according to guidelines.

• Completes out-of-state applications for plan enrollments of physicians and clinics

• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training: 

• High school diploma or equivalent required

Work Experience: 

• 3 years experience in working in the medical field which include a working knowledge of medical staff, third party payors, and organization preferred

Knowledge, Skills, and Abilities Required: 

• Knowledge of computer functions

• Knowledge of medical terminology, CPT-4 and ICD-9 coding

• Numerical ability required

• Organizational skills

• Excellent oral and written communication to communicate effectively with co-workers, supervisors and members of the medical staff

• Thorough on procedures and coordinating details

• Preference for contacts with people involving considerate tact and diplomacy

Physical Requirements: 

• Motor coordination and finger dexterity required to operate the calculator and computer terminal

• Reaching for and handling files

• Talking and hearing to give and receive information by phone

Required Licenses and Certifications

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity