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Credentialing Specialist

Epiphany Dermatology
Austin, TX
  • Posted: over a month ago
  • Full-Time
Job Description

At Epiphany Dermatology, we’re working hard to make sure everybody has immediate access to the best skin care possible regardless of location, insurance type, financial status, or scheduling needs. To accomplish this, we know we need the right people in our corner. 

Our employees are the key to our success and the reason why we were able to grow from a single location in 2015 to approximately 70 clinics spanning across 12 states today. We invest in our employees’ development and when they join the Epiphany Dermatology team it’s a career, not just another job.  

This position function is crucial in ensuring our providers are properly credentialed. In this role you will be responsible for processing, monitoring, and maintaining the credentialing and re-credentialing process for all providers. Facilitates all aspects of credentialing, as well as clinical privileging for Epiphany Dermatology providers and clinics. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy, integrity and management of the credentialing database system and related application

Essential Job Functions

  • Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
  • Maintain all aspects of the payer credentialing process for with the goal of becoming in-network providers for strategic insurance plans for multiple service lines.
  • Manages credentialing database system and related applications
  • Conducts thorough background investigation, research and primary source verification of all components of the application file.
  • Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
  • Prepares credentials file for completion and presentation to CEO/Medical Directors, ensuring file completion within time periods specified.
  • Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
  • Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
  • Leads care delegated credentialing audits; conducts internal file audits.
  • Participates in staff meetings and workgroups by providing constructive input for practice improvements and solutions.
  • Other duties as assigned.

Minimum Qualifications/Experience: 

  • High school diploma or equivalency certificate required: associate degree highly preferred.
  • Relevant healthcare billing/credentialing experience preferred.
  • Knowledge and understanding of the medical credentialing process, DEA certification, and CAQH and NHSC requirements preferred.

Work Environment and Physical Requirements: 

Medical office, procedure/exam room and laboratory environment may include exposure to communicable diseases, bloodborne pathogens, biohazards or toxic substances. Daily activities may include standing, walking, sitting, bending and lifting items up to 30 lbs. 

Benefits:

We offer generous benefits such as Free Medical, Dental, Vision, and Short-Term Disability for employee.  We also offer 401k (with company matching!), Employee Discounts, FSA/Dependent care, HSA, Paid Time Off (PTO), Long Term Disability, Accident, Life Insurance, plus more. 

Epiphany Dermatology

Address

Austin, TX
78730 USA

Industry

Healthcare

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