Credentialing Specialist
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Saint Joseph Medical Group
London, KY, US
Summary
The Credentialing Specialist coordinates the credentialing, re-credentialing, and payer enrollment processes for providers in accordance with regulatory requirements. They also manage daily credentialing operations and maintain the integrity of the medical staff database.
Job Description
Where You’ll Work
Welcome to CHI Saint Joseph Medical Group, a full service network of primary care services specializing in family, internal, geriatric and pediatric care serving 88 locations across central and Eastern Kentucky. CHI Saint Joseph Medical Group is dedicated to delivering customized care based on the unique needs of our patients and is recognized as a Best Place to Work in Kentucky for two years in a row (2023-2024).
CHI Saint Joseph Health is part of CommonSpirit Health, a non-profit, Catholic health system dedicated to advancing health for all people. With approximately 175,000 team members and 25,000 physicians and advanced practice clinicians.
Our commitment to serve the common good is delivered through the dedicated work of thousands of physicians, advanced practice clinicians, nurses, and staff; through clinical excellence delivered across a system of 140 hospitals and more than 2,200 care centers serving 24 states.
Job Summary and Responsibilities
As a Credentialing Professional, you will be responsible for coordinating the credentialing, re-credentialing, and payer enrollment process for providers in accordance with delegated credentialing agreements, policies and procedures, industry best practices, and regulatory requirements.Every day you will manage daily credentialing operations, including resolution of non-responsive providers. You will also work collaboratively with various clinic managers and the hospital medical staff office to ensure the successful and timely completion of the delegated credentialing and re-credentialing process.To be successful in this role, you will demonstrate a comprehensive understanding of credentialing regulations and processes, possess strong organizational and communication skills, and effectively manage complex administrative tasks to ensure provider compliance and efficient operational flow.
- Facilitates credentialing and re-credentialing for all physicians.
- Assist with processing pre-applications, provisional reviews, and periodic review of privilege criteria.
- Systematically evaluate work processes.
- Participate in conception, development and implementation of new programs.
- Maintains the medical staff database to ensure the upmost integrity of the system.
Job Requirements
Required
- Degree in Business or health related field and Experience with Microsoft Word, Excel, and Website applications, upon hire
Preferred
- Certified Provider Credentialing Specialist, upon hire or
- Prof Medical Services Manager, upon hire
Saint Joseph Health, part of CommonSpirit Health, is one of the largest and most comprehensive health systems in the Commonwealth of Kentucky with 100 locations in 15 cities, including hospitals, physician groups, clinics, primary care centers, specialty institutes, home health agencies and an ambulatory Care Center.
The hospitals in Saint Joseph Health are Flaget Memorial Hospital, Saint Joseph Berea, Saint Joseph East, Saint Joseph Hospital, Saint Joseph Jessamine, Saint Joseph London, Saint Joseph Mount Sterling, and Women’s Hospital at Saint Joseph East.
In total, the health system serves patients in 35 counties statewide. Saint Joseph Health is dedicated to providing a wide array of services to build a healthier future for all. Saint Joseph Health embodies a strong mission and faith-based heritage and works through local partnerships to expand access to care in the communities it serves.
Founded
2019
Company size
5,001-10,000 employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Lexington, Kentucky
Saint Joseph Health, part of CommonSpirit Health, is one of the largest and most comprehensive health systems in the Commonwealth of Kentucky with 100 locations in 15 cities, including hospitals, physician groups, clinics, primary care centers, specialty institutes, home health agencies and an ambulatory Care Center.
The hospitals in Saint Joseph Health are Flaget Memorial Hospital, Saint Joseph Berea, Saint Joseph East, Saint Joseph Hospital, Saint Joseph Jessamine, Saint Joseph London, Saint Joseph Mount Sterling, and Women’s Hospital at Saint Joseph East.
In total, the health system serves patients in 35 counties statewide. Saint Joseph Health is dedicated to providing a wide array of services to build a healthier future for all. Saint Joseph Health embodies a strong mission and faith-based heritage and works through local partnerships to expand access to care in the communities it serves.
Founded
2019
Company size
5,001-10,000 employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Lexington, Kentucky
