Credentialing Specialist

Posted:
10/21/2024, 11:18:26 AM

Location(s):
Metro Manila, Philippines ⋅ Makati, Metro Manila, Philippines

Experience Level(s):
Junior ⋅ Mid Level ⋅ Senior

Field(s):
Customer Success & Support

Workplace Type:
Hybrid

Epic Staffing Group (Epic), a portfolio company of The Pritzker Organization, is a fast-growing company that provides staffing solutions to the high-demand and rapidly expanding industries of Life Sciences and Healthcare (we are #404 on the Inc. 5000 list of Fastest-Growing Private Companies in America). Epic provides best-in-class staffing solutions across a variety of end markets through its deep sector expertise across life sciences and healthcare. Our Award-winning ‘client first’ culture and operational excellence drive industry-leading customer and candidate retention. We are already one of the largest staffing companies in our industry, and our rapid growth and ongoing expansion are creating opportunities at many levels. You can learn more about Epic Staffing Group below.
 

MAJOR DUTIES AND RESPONSIBILITIES: 
•    Perform all aspects of initial credentialing, recredentialing, and/or privileging, for the providers and/or clinical teams throughout the US.
•    Collect and verify sensitive provider and/or clinician data through confidential sources; manage, upload, and maintain compliance documents in required systems; regularly review reports to monitor completion of applications. 
•    Assess, evaluate, and interpret application and verification information to identify 'red flags' or areas of established non-compliance; communicate adverse, incomplete, or questionable data to appropriate parties and recommend appropriate course of action. 
•    Manage incoming and outgoing communications between multiple parties while meeting policy timelines and updating the credentialing database; provide status reports and communicate provider and/or clinician participation information to internal and external customers. 
•    Provide written and verbal communication with federal, state, and local agencies, hospitals, medical review boards, educator review boards, and malpractice carriers to obtain provider and practitioner information. 
•    Participate in preparation for Internal and external audits conducted for current and accurate provider and/or clinician information or delegation compliance; audit files based on internal standards and regulatory / accreditation requirements (e.g., CMS, DSHS, NCQA & JCAHO, DNV), if applicable. 
•    Assist providers and/or clinicians with setting up appointments (e.g., physicals, drug screens, PPDs, Chest X-rays, titers, vaccinations, fit tests, color tests, etc.).
•    Maintain positive relationships, written and verbal communication, and high levels of both internal and external customer service with customers, vendors, employees, and other parties related to company’s credentialing efforts.
•    Remain current with the research, review and interpretation of applicable accreditation, licensing, and other regulatory requirements to ensure credentialing policies and policies continually meet requirements. 
•    Participate in design and development of forms, workflows, processes, etc., to support credentialing processes.
•    Maintain documentation of credentialing activities, such as feedback received from fellow colleagues and review and escalate when needed. 


Other Duties
•    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 and may vary based on the needs of the Strategic Business Unit (SBU).
•    This job description does not include performance metrics, which may vary by position.


 QUALIFICATIONS: 
•    Graduation from high school or educational equivalent
•    One year of experience in education or healthcare staffing credentialing

Certified Provider Credentialing Specialist (CPCS) can substitute for experience.


KNOWLEDGE, SKILLS, AND ABILITIES: 
•    Ability to handle personal information professionally and confidentially.
•    Adaptability to change and ability to prioritize competing duties.
•    Expert computer skills, including full suite of Microsoft Office: Word, Excel, Outlook, and PowerPoint.
•    Working knowledge of TJC, Federal and State Healthcare and Education regulations, including HIPAA and FERPA preferred.
•    Ability to make appropriate decisions regarding the credentialing process without constant guidance from supervisor.
•    Strong organizational and written/verbal interpersonal skills, along with strong attention to detail.
•    Ability to manage multiple priorities and competing deadlines.
•    Professional attitude, tone, and demeanor.
•    Knowledge of common medical records e.g., physicals, vaccines, titers, drug screens, background checks, etc.

What's in store for you at Epic?

  • Competitive salary package, quarterly performance bonus

  • HMO (medical and dental) & Life Insurance coverage

  • Paid vacation and sick leave credits. All unused leave credits are convertible to cash by end of the year

  • Additional Covid-19 vaccine and birthday leave credits

  • Extra allowances will be given for WFH set-up such as internet subsidy and transportation allowance for WFO set-up

  • Medicine & Optical reimbursements

  • Perfect Attendance bonus

  • Career development and advancement opportunities