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Become A Credentialing Specialist

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Working As A Credentialing Specialist

  • Interacting With Computers
  • Getting Information
  • Documenting/Recording Information
  • Organizing, Planning, and Prioritizing Work
  • Processing Information
  • Deal with People

  • Mostly Sitting

  • Repetitive

  • $33,040

    Average Salary

What Does A Credentialing Specialist Do At Community Health Systems

* Following-up on and gathering credentialing documentation,obtaining information from the provide.
* Completing documentation with required information andsubmitting to each insurance carrier according to their specific guidelines.
* Set up new entity and obtain group provider numbers forentity and providers.
* Obtain required credentialing paperwork from insurancecompanies.
* Complete paperwork with required information from existingcredentialing files and/or in conjunction with the physician or non-physicianprovider.
* Upon completion of paperwork and after ensuring propriety,forward paperwork to insurance companies to be assigned the necessary provideridentification numbers.
* Field telephone or written inquiries, questions and concernsfrom insurance companies and physician or non-physician providers regarding thestatus of provider identification numbers.
* Qualifications
* KNOWLEDGE

What Does A Credentialing Specialist Do At Kelly Services

* Customer service liaison between Medical Center departments, physicians and their staff, hospitals and regulatory agencies on credentialing requirements and activities.
* Responds and provides follow-up to inquiries from external organizations, prospective appointees, department practitioners, and Medical Center departments.
* Assures appropriate follow-through, required documentation/records and the timely distribution of information; maintains confidentiality of information and keeps accurate records.
* Assists with and performs quality check for credentialing, privileging, new appointment, reinstatements, and reappointment processes of physicians and related activities.
* Verifies standards and criteria in accordance with department rules and regulations.
* If you are interested in learning more about the position and would like to apply please free to give us a call at 808
* or apply here

What Does A Credentialing Specialist Do At Catholic Health Initiatives

* Performs credentialing and re-credentialing processes according to departmental policies and procedures, various accreditations standards, health plan, state and Federal requirements.
* Provides assistance and guidance to physicians and professional providers through the hospital privileging processes.
* Prepares files, letters and summaries for Medical Staff Office and/or Franciscan Medical Group (FMG) Credentialing Committee review.
* Maintains all written/verbal correspondence and data collection records regarding provider status and credentialing process.
* Assists with productivity reporting.
* Assists in preparation for health plan delegation oversight audits.
* Qualifications

What Does A Credentialing Specialist Do At The Arora Group

* SPECIALIST INCLUDE:
* Conducts primary source verification of healthcare professionals’ credentialing documents and qualifications in accordance requirements of government contracts, The Joint Commission, and/or The National Committee for Quality Assurance as well as the health care worker’s professional level.
* Interfaces with potential candidates, employees, and project managers to facilitate compilation of credentialing documents.
* Creates new credentials files and maintains databases of healthcare credentialing information and expiration dates in company applicant tracking system/CRM.
* Ensures healthcare professionals maintain requisite unexpired qualifications.
* Ensures strict compliance with accreditation standards and legal requirements related to healthcare staff.
* Assists in conducting market and salary research.
* Performs other administrative tasks and projects to support the corporate office

What Does A Credentialing Specialist Do At Robert Half

* Board updates
* Maintains Medical Staff database
* Data is entered into system of each new applicant as indicated by each data screen
* Reappointment date is entered according to licensure month
* New reappointment dates are entered for newly reappointed practitioners after Board of Trustees approval
* Updates roster of the medical staff which is prepared following each Board meeting and sent to Department Chairs and Department secretaries
* Current insurance verification is maintained 3.
* Processes initial applications
* Full verification of all information and collections of all additional documents needed, e.g. license, references, NPDB report, Medicare/Medicaid sanction report, AMA profile, claims history, affiliations, and according to the Medical Staff Services Policy and Procedure

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How To Become A Credentialing Specialist

High school graduates who have experience using computer software applications, such as word processing and spreadsheets, usually qualify for entry-level positions. Although most secretaries learn their job in several weeks, many legal and medical secretaries require additional training to learn industry-specific terminology. Executive secretaries usually need several years of related work experience.

Education

High school graduates can take courses in word processing and office procedures at technical schools or community colleges. Some temporary placement agencies also provide training in word processing, spreadsheet, and database software.

Some medical and legal secretaries learn industry-specific terminology and practices by attending courses offered at community colleges or technical schools. For executive secretary positions, employers increasingly prefer to hire those who have taken some college courses or have a bachelor’s degree.

Training

Secretaries and administrative assistants typically learn their skills through short-term on-the-job training, usually lasting a few weeks. During this time they learn about administrative procedures, including how to prepare documents. Medical and legal secretaries’ training may last several months as they learn industry-specific terminology and practices.

Work Experience in a Related Occupation

Executive secretaries can gain experience by working in administrative positions that have less challenging responsibilities. Many secretaries and administrative assistants advance to higher level administrative positions.

Licenses, Certifications, and Registrations

Although not required, certification can demonstrate competency to employers.

The International Association of Administrative Professionals offers the Certified Administrative Professional (CAP) certification. Candidates must have a minimum of 2 to 4 years of administrative work experience, depending on their level of education, and pass an examination.

Legal secretaries have several certification options. For example, those with 1 year of general office experience, or who have completed an approved training course, can acquire the Accredited Legal Professional (ALP) certification through a testing process administered by NALS (previously known as National Association of Legal Secretaries). NALS also offers the Professional Legal Secretary (PLS) certification, considered to be an advanced certification for legal support professionals.

The Certified Legal Secretary Specialist (CLSS) certification is conferred by Legal Secretaries International in areas such as intellectual property, criminal law, civil litigation, probate, and business law. Candidates typically need to have 5 years of legal experience and pass an examination to become certified.

Advancement

Secretaries and administrative assistants generally advance to other administrative positions with more responsibilities, such as office supervisor, office manager, or executive secretary.

With additional training, many legal secretaries become paralegals or legal assistants.

Important Qualities

Integrity. Many secretaries and administrative assistants are trusted to handle sensitive information. For example, medical secretaries collect patient data that is required, by law, to be kept confidential in order to protect patient privacy.

Interpersonal skills. Secretaries and administrative assistants interact with clients, customers, or staff. They should communicate effectively and be courteous when interacting with others to create a positive work environment and client experience.

Organizational skills. Secretaries and administrative assistants keep files, folders, and schedules in proper order so an office can run efficiently.

Writing skills. Secretaries and administrative assistants write memos and emails when communicating with managers, employees, and customers. Therefore, they must have good grammar, ensure accuracy, and maintain a professional tone.

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Credentialing Specialist jobs

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Credentialing Specialist Career Paths

Credentialing Specialist
Provider Relations Representative Billing Specialist Specialist
Account Manager
5 Yearsyrs
Billing Manager Accounts Receivable Specialist Staff Accountant
Accounting Manager
7 Yearsyrs
Business Office Manager Accountant Staff Accountant
Accounts Receivable Manager
6 Yearsyrs
Billing Manager Business Office Manager
Business Office Director
8 Yearsyrs
Contracts Specialist Contracts Administrator Human Resources Coordinator
Business Office Manager
8 Yearsyrs
Program Manager Service Director Therapist
Clinical Manager
8 Yearsyrs
Recruiter Human Resources Manager
Director Of Human Resources
10 Yearsyrs
Project Coordinator Business Analyst Senior Finance Analyst
Finance Manager
7 Yearsyrs
Recruiter Recruitment Manager
Human Resources Manager
7 Yearsyrs
Medical Staff Coordinator Physician
Medical Director
9 Yearsyrs
Contracts Specialist Program Manager Center Director
Office Manager
5 Yearsyrs
Data Analyst Project Manager Program Manager
Operations Director
9 Yearsyrs
Provider Relations Representative Account Manager Sales Manager
Operations Manager
7 Yearsyrs
Business Office Manager Case Manager Registered Nurse Case Manager
Patient Care Manager
9 Yearsyrs
Human Resources Manager Registered Nurse Nurse Manager
Patient Services Manager
8 Yearsyrs
Program Manager General Manager Business Manager
Practice Administrator
10 Yearsyrs
Data Analyst Business Analyst Project Manager
Program Manager
8 Yearsyrs
Medical Staff Coordinator Medical Director Chief Executive Officer
Property Manager
6 Yearsyrs
Provider Enrollment Specialist Analyst Quality Assurance Analyst
Quality Assurance Manager
9 Yearsyrs
Project Coordinator Program Manager General Manager
Regional Manager
8 Yearsyrs
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Credentialing Specialist Demographics

Gender

  • Female

    84.5%
  • Male

    13.4%
  • Unknown

    2.1%

Ethnicity

  • White

    79.5%
  • Hispanic or Latino

    11.9%
  • Asian

    6.5%
  • Unknown

    1.5%
  • Black or African American

    0.7%
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Languages Spoken

  • Spanish

    69.3%
  • French

    6.3%
  • Portuguese

    3.1%
  • Russian

    2.4%
  • Cantonese

    2.4%
  • Italian

    2.4%
  • Chinese

    1.6%
  • German

    1.6%
  • Carrier

    1.6%
  • Mandarin

    1.6%
  • Serbian

    0.8%
  • Lithuanian

    0.8%
  • Hebrew

    0.8%
  • Dakota

    0.8%
  • Japanese

    0.8%
  • Amharic

    0.8%
  • Hindi

    0.8%
  • Arabic

    0.8%
  • Korean

    0.8%
  • Croatian

    0.8%
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Credentialing Specialist

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Credentialing Specialist Education

Credentialing Specialist

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Top Skills for A Credentialing Specialist

ProviderFilesProviderCredentialsProviderDataProceduresMedicalStaffMalpracticeInsuranceDEAHealthCareProvidersMedicalProfessionalsPrimarySourceVerificationNcqaHospitalPrivilegesCaqhMedicaidHealthPlanInsuranceCompaniesDataEntryBoardCertificationCustomerServiceHealthProfessionals

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Top Credentialing Specialist Skills

  1. Provider Files
  2. Provider Credentials
  3. Provider Data
You can check out examples of real life uses of top skills on resumes here:
  • Maintained provider files and documentation of current professional licensees and certifications as well as planned participation through the health insurance carriers.
  • Obtained missing information from physician offices and verified provider credentials.
  • Maintained provider data base, which included demographic, billing and credentialing information on each participating provider.
  • Created policies, procedures, letters, and forms, tracking systems, files and databases for both organizations.
  • Collaborate with medical staff, risk units and other pertinent personnel to facilitate timely and efficient credentialing process.

Top Credentialing Specialist Employers

Credentialing Specialist Videos

How Long Does Medical Credentialing Take?

CHES/MCHES Employer Video

Aboriginal Projects for 2016 Credentialing a New Workforce

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