About the Role

The Medical Credentialing Specialist is responsible for ensuring that healthcare providers are properly credentialed and in compliance with all regulatory and organizational standards. This role involves verifying the credentials, licensures, certifications, and background of medical professionals to maintain compliance with industry standards and legal regulations. The Credentialing Specialist plays a key role in maintaining the integrity and quality of care provided by the organization by ensuring that healthcare providers meet all necessary requirements.

This position is a crucial part of the revenue cycle and payer enrollment process, as it ensures that providers are properly credentialed, which is the first step in successful payer enrollment and reimbursement.

This is a full-time remote position. The work week is typically Monday through Friday. A reliable internet connection is required, all necessary equipment will be provided by the company.

What You'll Be Doing

• Process and maintain all clinical credentialing and re-credentialing applications for healthcare providers, ensuring accurate and timely completion.
• Uses various methods to track all credentialing processes from inception through completion.
• Actively participates in department meetings, Provides weekly progress updates to Director of department.
• Verify healthcare providers' licensure, certification, education, training, and other credentials in compliance with organizational and regulatory standards.
• Maintain accurate and up-to-date records of all credentialing documentation in both physical and electronic formats.
• Submit applications and renewals for provider credentials with healthcare organizations, insurance companies, and regulatory bodies.
• Communicate with healthcare providers, insurance companies, and regulatory agencies regarding credentialing issues, deadlines, and documentation requirements.
• Track the expiration of licensure and certifications, ensuring timely renewals to maintain uninterrupted practice.
• Annually completes all malpractice/ excess liability insurance applications.
• Ensure compliance with all accreditation, regulatory, and licensure requirements, such as those set by the National Committee for Quality Assurance (NCQA) , AAAHC, Quad A, ACHC.
• Utilize credentialing software such as VerityStream to manage provider enrollment, credentialing, and privileging processes.
• Performs primary source verifications and exclusion checks, including conducting National Provider Data Bank (NPDB) reporting and updates, as well as verifying provider status through exclusion databases.
• Prepare credentialing packets to be presented to the committee for review and approval of privileges, ensuring all necessary documentation is included. Attend committee meetings as needed to provide information and respond to questions related to provider credentials and privileges.
• Manage initial enrollment and ongoing maintenance of provider credentials in Medicare using PECOS and ensure Medicaid enrollment for each provider.
• Initiate payer enrollment process with ProCred and work collaboratively with ProCred to complete payer enrollment and communicate weekly updates to relevant departments.
• Collaborate with other departments, including Operations, Human Resources, Contracting, Payer Enrollment and Billing, to ensure credentialing processes align with overall organizational goals.
• Troubleshoot and resolve any credentialing discrepancies or issues that may arise.
• Maintains excellent knowledge of all facets of the credentialing and payer enrollment processes.
• Utilize Microsoft Office Suite (Word, Excel, Outlook) for various administrative tasks, create and develop forms using Adobe Acrobat, and manage electronic signatures and document workflows using DocuSign.

What We Expect from You

• High school diploma or equivalent required; associate's or bachelor's degree in healthcare administration or a related field preferred.
• Previous experience in medical credentialing, provider enrollment, or healthcare administration 2-3 years preferred.
• Knowledge of healthcare credentialing procedures, insurance billing processes, and regulatory requirements.
• Experience using credentialing software such as VerityStream, CAQH, or other similar platforms preferred.
• Excellent organizational skills with strong attention to detail, ensuring tasks are completed accurately and within deadlines through effective time management.
• Excellent communication and interpersonal skills, with the ability to effectively convey information both verbally and in writing when working with healthcare providers, insurance companies, and regulatory agencies.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook), experience with Adobe Acrobat for form creation and development, and familiarity with DocuSign for electronic signatures and document management.
• Ability to work independently and manage multiple tasks in a fast-paced environment.

Preferred Skills:

• Familiarity with credentialing databases and software such as VerityStream, CAQH, MDStaff, or similar systems.
• Experience with NCQA, URAC, or The Joint Commission accreditation standards.
• Knowledge of state and federal healthcare regulations, as well as insurance provider requirements.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills

To perform this job successfully, an individual should have thorough knowledge in computer information systems.

Physical Demands

Work is primarily conducted in a remote setting, requiring prolonged periods of sitting. Physical requirements include good eye-hand coordination and manual dexterity to operate a keyboard and necessary computer equipment. The role also necessitates a normal range of hearing and eyesight to accurately record, prepare, and communicate relevant documents. The company is committed to making reasonable accommodations for employees with physical needs to ensure a comfortable and productive work environment.

Work Environment

This is a full-time remote position. The work week is typically Monday through Friday. A reliable internet connection is required, all necessary equipment will be provided by the company

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Travel

Travel is not expected for this position, although if associate lives in the area of one of our local offices hybrid work arrangements and office accommodations can be made to meet associate and or company needs. Although rare some out-of-the-area and overnight travel may be expected.

What We are Offer You

At U.S. Urology Partners, we are guided by four core values. Every associate living the core values makes our company an amazing place to work. Here "Every Family Matters"

Compassion

Make Someone's Day
Collaboration

Achieve Possibilities Together
Respect

Treat people with dignity
Accountability

Do the right thing

Beyond competitive compensation, our well-rounded benefits package includes a range of comprehensive medical, dental and vision plans, HSA / FSA, 401(k) matching, an Employee Assistance Program (EAP) and more.

About US Urology Partners

U.S. Urology Partners is one of the nation's largest independent providers of urology and related specialty services, including general urology, surgical procedures, advanced cancer treatment, and other ancillary services. Through Central Ohio Urology Group, Associated Medical Professionals of NY, Urology of Indiana, and Florida Urology Center, the U.S. Urology Partners clinical network now consists of more than 50 offices throughout the East Coast and Midwest, including a state-of-the-art, urology-specific ambulatory surgery center that is one of the first in the country to offer robotic surgery. U.S. Urology Partners was formed to support urology practices through an experienced team of healthcare executives and resources, while serving as a platform upon which NMS Capital is building a leading provider of urological services through an acquisition strategy.

U.S. Urology Partners is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.