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Credentialing Specialist

Universal Health Services

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Universal Health Services
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Job Details

Credentialing Specialist

Job Code:  238429
Facility: Independence Shared Services
Location: KING OF PRUSSIA, PA US Mid-Atlantic
Region: Mid-Atlantic
Travel Involved: 0-10%
Job Type: Full Time
Job Level: 
Minimum Education Required: Vocational 
Category: Office/Clerical
FTE: 1
Position Summary:

The Credentialing Specialist position ensures that the credentialing requirements for governmental agencies and commercial managed care insurers/networks are met and managed appropriately and timely so that physicians are enrolled in and maintain active credentialing status with such entities. Also responsible for credentialing, as assigned, to other IPM physician group models.

Submits credentialing to all contracted commercial payors and government agencies timely and accurately.

Coordinates efforts with the hospital CPS office and Physician Recruitment Team to ensure that all new physicians’ credentials are obtained as early as possible to ensure the credentialing process is expedited.

Supports other IPM locations with credentialing as needed and maintains close working relations with appropriate contacts to keep them well informed. Maintains appropriate tracking of time and promptly reports it on a weekly basis as established by the Credentialing Department.

Performs credentialing as requested by contracted managed care companies and ensures timely submission and follow up as necessary.

Supports other physicians recruited by hospital under a guarantee in efforts to perform credentialing functions as needed and agreed upon by physician and Credentialing Manager.

Coordinates on-site credentialing audits to ensure that contract compliance and requirements are met.

Maintains managed care contract files (paper and electronic) and department databases for contracts and credentialing.

Maintains contract files as appropriate for external physician contracting and credentialing on behalf of other IPM locations.

Ensures that demographic changes to contracted physicians are promptly reported to all contracted managed care companies and governments agencies.

Keeps all internal departments informed of any contracted payor changes that may impact day to day operations.

Enters and maintains data in the credentialing database, Intellisoft, according to established data entry rules and policies. Performs database queries and reports as needed.

Acts as liaison with the Central Business Office (CBO) as point person to ensure compliance and delivery of required information in a timely manner.

Actively engages in supporting department contracting and negotiation efforts as needed.

Assists internal departments with questions and issues. Performs other duties and works on special projects as requested.


Education:  Technical School/2 Years College / Associate’s Degree required; Bachelor's degree preferred.  One to three years' related experience required; three to five years' related experience preferred.

Comprehensive knowledge of the managed care industry, with specific emphasis on physician credentialing and/or physician contracting requirements. A broad understanding of the managed care contracting process is required and knowledge of managed care payers processes. Responsible for credentialing activities as it relates to initial credentialing, re-credentialing, and credentials modification. Ability to communicate effectively both verbally and in writing with internal departments, physicians, physician group management staff and managed care companies in order to achieve the necessary results required in the credentialing process and support of the Credentialing Department.

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