GENERAL SUMMARY OF DUTIES: The Credentialing Specialist will be responsible for evaluating, analyzing, and coordinating all aspects of the credentialing and recredentialing process for practitioners to enable a timely onboarding of healthcare providers.

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REPORTS TO: *Director, Payer Relations

RESPONSIBILITIES:
Duties may include but are not limited to:

• Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for the credential’s verification process.
• Responsible for gathering, verifying highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standards
• Efficiently perform all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner files
• Respond to all practitioner, client health plan and internal inquiries in a timely manner
• Monitor expiring licensure, board, and professional certifications and other expirable documents with practitioners within the prescribed timeframe
• Responsible for accurate data entry to endure the integrity of credentialing information in applicable database(s)
• Collaborate with participating clients, department manager and /or external agencies to facilitate and ensure smooth hand-off during the credentialing process
• Use critical thinking skills to conduct follow-up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process.

REQUIRED EDUCATION, SKILLS & EXPERIENCE:
Bachelor’s degree in business, healthcare or related filed and 3-5 years of progressive experience in credentialing and provider enrollment strongly preferred. 10+ years of credentialing/enrollment and/or revenue cycle management experience may be substituted in place of a degree.

Working knowledge of credentialing and enrollment software preferred, ideally Verity Credential Stream. Knowledgeable in all aspects of provider credentialing and enrollment, including knowledge of regulatory & compliance standards, credentialing processes, commercial and government insurance enrollment, and medical staff privileging. Must be proficient in Microsoft Office suite. Strong communication skills from team level to peer level to C-suite level required.

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PHYSICAL/MENTAL/ENVIRONMENTAL DEMANDS*
Requires sitting and standing associated with a normal office environment. Travel (local and nationwide) as business needs dictate.

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DRUG FREE WORKPLACE*
United Digestive is a drug free workplace. All offers of employment are contingent upon passing a pre-employment drug screening.

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EQUAL OPPORTUNITY EMPLOYER*
United Digestive MSO Parent, LLC is an Equal Opportunity Employer and does not discriminate based on race, religion, gender, color or national origin in its employment practices.

Location: 1355 Peachtree Street NE STE 1600, Atlanta, GA 30309

Job Type: Full-time

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