Credentialing Specialist

Description ABOUT AUSTIN REGIONAL CLINIC: Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 15 years! We are one of central Texas’ largest professional medical groups with 35+ locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit https://www.austinregionalclinic.com/careers/ PURPOSE Participates in and performs the credentialing and re-credentialing processes for providers to ensure credentialing/re-credentialing and projects are completed in a timely manner. Meets the standards as set forth in the Credentialing Policies and Procedures and NCQA compliance. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization. ESSENTIAL FUNCTIONS Gathers, researches, compiles and documents physician data used in the credentialing process. Investigates discrepancies, reports and documents findings. Maintains databases/records of required provider information, including but not limited to licensures and documents. Performs new provider credentialing activities including preparation of new provider files to be presented to the Board or Credentialing Committee per NCQA Standards. Ensures new Providers have hospital membership at all appropriate hospitals within the allotted time frame. Ensures new provider applications (Medicare/Medicaid/Tricare/TCMS/TMA, etc.) are submitted timely and follows through to completion. Performs the re-credentialing process to ensure all providers are re-credentialed within the re-credentialing renewal cycle. Assists in preparing reports of any discrepancies to the Board or Credentialing Committee. Ensures hospital privilege applications are sent to the appropriate facilities in a timely manner and addresses additional requests relating to such as necessary. Ensures credentialing files are kept current and orderly. Monitors/ tracks Medicare and Medicaid enrollment process. Addresses necessary issues regularly. Monitors licensure/insurance expiration date activity for both internal and external providers. Monitors all required regulatory websites as required by NCQA Standards. Documents findings. Reports any issues identified to Supervisor. Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct. Regular and dependable attendance. Follows the core competencies set forth by the Company, which are available for review on CMSweb. OTHER DUTIES AND RESPONSIBILITIES Provides regular workload/productivity reports to supervisor. Responds professionally and effectively to questions from external sources, i.e., customer or carrier, and internal sources, i.e., provider or management team. Attends required in-services, training sessions, and department meetings. Performs other duties as assigned. QUALIFICATIONS Education and Experience Required: High school diploma or GED. One (1) or more years of clerical experience. Preferred: Experience working in credentialing and/or medical office. Experience using credentialing software. Knowledge, Skills and Abilities Excellent computer and keyboarding skills, including familiarity with Windows. Excellent verbal and written communication skills. Excellent attention to detail. Excellent customer service skills. Excellent interpersonal & problem solving skills. Ability to work in a team environment as well as independently. Ability to engage others, listen and adapt response to meet others’ needs. Ability to align own actions with those of other team members committed to common goals. Ability to organize and prioritize own work schedule. Ability to manage competing priorities. Ability to perform job duties in a professional manner at all times. Ability to understand, recall, and communicate, factual information. Ability to understand, recall, and apply oral and/or written instructions or other information. Ability to organize thoughts and ideas into understandable terminology. Ability to apply common sense in performing job. Work Schedule: Monday - Friday 8AM - 5PM (Hybrid)