Credentialing Specialist - 1199 Seiu National Benefit Fund : Job Details

Responsibilities Perform primary provider source verifications of license, Drug Enforcement Administration (DEA) number, hospital affiliation, board certification status, malpractice history and sanction activity through various web-based agencies and sources Research and summarize provider's malpractice history for Credentialing Committee review Enter and review provider information in Trinity system; prepare reports as needed Confirm authenticity of documents and ensure pre-established criteria has been met; return provider applications that do not meet criteria Verify and review provider applications, participation agreements or designations of provider groups for completion Follow up with providers or office managers in regard to missing or expired information in the credentialing application or documentation Check provider status files for duplication and possible conflicting information Perform statistical analysis via Excel spreadsheet Perform additional duties and projects as assigned by managementQualifications High School Diploma or GED required, some College or Degree preferred Minimum two (2) years administrative experience in a general office environment required and two (2) years credentialing experience in a managed care or medical environment preferred Experience with Provider Relations' practices, business processes and credentialing databases (i.e. Cactus) preferred Basic skill level in Microsoft Word and Excel required Excellent interpersonal and communications skills - both written and verbal Strong analytical, problem-solving, time management, planning and organizational skills Must possess excellent critical thinking and analytical capabilities, excellent attention to detail and accuracy Ability to work well under pressure to meet deadlines and able to multi-task effectively and follow through on assignments to completion Must be able to work well independently with minimal supervision, able to exercise good judgment and be a team player Ability to establish and maintain effective working relationships with providers, staff, and other agencies; provide a positive service attitude when dealing with internal and external customers