Atlanta - GA Full Time 2 months ago

POSITION SUMMARY:The Credentialing and Enrollment Specialist works with the finance, quality, and clinical departments to ensure that licensed independent practitioners at Mercy Care are appropriately credentialed and privileged for appointment to and ongoing service on the Mercy Care clinical staff. The Specialist also coordinates credentialing and enrollment with third party payors for Mercy Care facilities, employed practitioners and others as appropriate. By complying with the procedures of regulatory and accrediting bodies and Mercy Care policy, the Specialist plays a vital and initial role in ensuring that practitioners are properly trained, currently competent and able to provide the highest quality of health care service. The Specialist maintains accurate credentials and enrollments database(s).

The Specialist will recognize situations where the documentation provided by the practitioner or for the facility may not meet criteria established by Mercy Care policy and will bring any possible issues to the attention of the Director of Quality or other management personnel, as appropriate. The Specialist should be able to determine those applications for initial or re- appointment that have no issues and can be brought forward for review. The Specialist will employ a tracking system that will be used for tracking credentialing, enrollment, reaccreditation and revalidation. EDUCATION REQUIREMENTS: Associates Degree In Business or Health Care Administration or experience commensurate with education.EXPERIENCE REQUIREMENTS: Desired 2-5 years related healthcare and/or managed care credentialing experience.

Preference given to Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) candidates.JOB KNOWLEDGE AND SKILLS: Strong skills in organization, prioritization, and communication are essential. Self-motivation and the ability to work with minimal supervision are expected. Also expected are: (1) discretion in handling confidential information (2) computer competence with regard to database management and Microsoft Office products (3) excellent written and oral communication skills (4) strong interpersonal skills for interaction with administration, staff members, providers, and outside parties.Our Commitment to Diversity and InclusionTrinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes.

We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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