Internal Credentialing Specialist II

Job Description

Job Description

This is an in-office position based in our Fort Myers, FL, and Brookhaven, Atlanta offices.

About Us:

TeleSpecialists is transforming healthcare delivery as the nation's largest and fastest-growing digital healthcare leader. By providing expert neurological and psychiatric care directly to over 400 hospitals and health systems across the country, we don't just provide care; we pioneer solutions that make quality healthcare easily accessible.

Join a team where your passion meets our purpose. If you’re inspired by innovation, thrive in a collaborative and entrepreneurial environment, and want to be a part of a team that’s reshaping the future of patient care, we want you on our team. At TeleSpecialists, you'll discover more than just a job. You will be able to experience meaningful work, accelerated career growth, and the opportunity to redefine healthcare for the future.

Tele Specialists Offers:

• A great culture with a team environment
• A fun, diverse work environment
• A rapidly growing company with career advancement opportunities
• Medical, Dental and Vision benefits
• 401k match
• Paid Vacation
• Leadership Training Classes
• Mentorship Program
• Tuition Reimbursement

About the Role :

The Internal Credentialing Specialist II is responsible for the completion of all new physician applications. The Internal Credentialing Specialist II ensures all providers information is complete and accurate, and all appropriate documents are maintained and current with the credentialing system.

This position also ensures that the management team is made aware of any potential issues with all inventory and processes.

Essential Duties and Responsibilities :

• With the guidance of the Internal Credentialing Manager will complete the credentialing verification process for all physicians applying for a Tele-Neurology and Tele-Psychiatry contract
• Identifies and analyzes the physician information received to ensure accuracy
• Enters, logs, and scans information into credentialing system for initial, updated, and maintenance processes
• Ensures that all credentialing verifications are obtained via primary source verifications:
  1. All training, expired, and current state licenses
  2. All past and current DEA, CDS, and CSR when applicable
  3. Board certifications
  4. Malpractice and Claims History for insurance carriers for the last 10 years
  5. Sanction Checks (OIG and SAM)
  6. Graduate, Medical School, Internship, Residency, and Fellowship (Education and Post-graduate training)
  7. 3 peer references
  8. Complete a NPDB Self-Query
  9. FCVS, ECFMG, USMLE, NBME, NBOME, if applicable
  10. Background Check
• Obtains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all physicians during the Internal Credentialing process
• Tracks the credentialing application process in order to promote compliance, process enhancement, and efficiency
• Follows up on any missing information needed to complete the credentialing process
• Ensures departmental guidelines are followed to support all Internal Credentialing policies and procedures
• Makes leadership aware of any potential derogatory issues identified during the credentialing process and works in collaboration with practitioner to document/resolve the issue
• Other duties as assigned

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to interact with internal and external customers
• Flexible and adaptable in regard to learning and understanding new technologies
• Highly analytical and detail-oriented with ability to demonstrate command of details and to articulate those details at a higher level.
• Strong written, oral and interpersonal communication skills
• Highly self-motivated, directed and proactive
• Keen attention to detail
• Ability to effectively prioritize and execute tasks in a high-pressure environment
• Experience working both independently and, in a team-oriented, collaborative environment
• Able to communicate effectively within department and with members of interdisciplinary teams
• Ability to work independently and proactively in a fast-paced, dynamic environment
• Proven analytical and problem-solving abilities

Education/Experience:

• High School Diploma or equivalent required
• Hospital Privileging Medical Staff Office, Credentialing, or Licensing experience preferred
• Sales Force experience preferred
• Certified Provider Credentialing Specialist (CPCS) through National Association of Medical Staff Services a plus

Computer Skills:

To perform this job successfully, an individual should have knowledge of:

• Microsoft Office Suite
• Credentialing software

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift 15 pounds at time