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RESPONSIBILITIES

I. JOB SUMMARY/RESPONSIBILITIES:

• Responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payors, Medicare and Medicaid.

• Performs credentialing in accordance with policies and procedures of The Queen’s Health Systems (QHS) and in compliance with federal, state, insurance carriers, health plans and other third party payor requirements.

II. TYPICAL PHYSICAL DEMANDS:

• Essential: standing, sitting, walking, seeing, hearing, speaking, finger dexterity, repetitive arm/hand motions and gripping of an object.

• Operates various office equipment such as computer, copier, facsimile, telephone, typewriter, etc.

III. TYPICAL WORKING CONDITIONS:

• Not substantially subjected to adverse environmental conditions.

• Some exposure to communicable diseases and other conditions common to a hospital and office environment.

IV. MINIMUM QUALIFICATIONS:

A. EDUCATION/CERTIFICATION AND LICENSURE:

• High school diploma or equivalent education.

• Associate’s or Bachelor’s degree in business administration, finance, accounting or healthcare related field preferred.

B. EXPERIENCE:

• One (1) year experience in provider credentialing, preferably in a comparable organization.

• Knowledge of Medicaid, Medicare, Third Party payer requirements, SNF/ICF, ICD-10 and DRG’s.

• Knowledge of medical terminology.

• Detail oriented with strong organizational skills.

• Experience and/or background to demonstrate effective written and verbal communication skills in English.

• Experience with Windows applications, such as Word, Excel, etc., demonstrated proficiency in using mouse and keyboard.

• Experience with computer based applications, preferably in SMS and/or EPIC systems.

Equal Opportunity Employer/Disability/Vet