Provider Relations Credentialing Specialist

Summary: Under the direct supervision of Vice President, Provider Relations, and with general responsibility to the Provider Relations division, this position is responsible for accurate and timely provider (re)credentialing support, and computerized file maintenance.

Specific Duties:

Under the general direction and guidance of the Director, Provider Relations, and through specific direction provided by the person for whom work is performed:

1. Serve as liaison for providers in (re)credentialing process. Assist in resolving problems on a timely basis.

2. Initiate (re)credentialing process upon receipt of application. Review provider and primary source responses. Refer all responses not meeting BHS credentialing criteria to Vice President, Provider Relations.

3. Perform National Practitioner Data Bank queries and internet state licensure board verifications.

4. Maintain computerized provider system, including preparing data conversions for network providers, and entering current credentialing/quality assurance information.

5. Verify and update provider information upon request or receipt of incorrect provider claim(s).

6. Assist in preparation and set-up of Provider Relations meetings and panels.

7. Prepare reports as requested.

8. Attend quarterly credentialing committee meetings, as requested.

9. Maintain all information in a confidential manner.

10. Adhere to established policies and procedures as directed.

11. Perform other related duties and special projects as directed.

Qualifications:

– High school diploma, some college preferred
– 3 years extensive data entry experience
– Minimum 60 WPM typing
– Proficiency in MS Word and Access required
– Advanced PC computer software skills (i.e., spread sheets, special programs)
– Familiarity with internet
– Accuracy and attention to detail
– Excellent proofreading skills
– Good organization and written communication skills
– Ability to meet deadlines/handle interruptions/problem-solve
– Cooperative attitude and self-starter
– Superior disposition and telephone communication skills
– Dependability and punctuality
– Ability to work with a minimum of supervision
– Alabama driver’s license and dependable transportation
– Provider credentialing or provider systems experience (or related provider relations experience) required