Credentialing Specialist

Overview

Independence Physician Management (IPM) was formed in 2012 as the physician services unit. IPM develops and manages multi-specialty physician networks and urgent care clinics within the Acute Care and Behavioral Health Divisions. A subsidiary of UHS, IPM operates in 13 markets across 7 states. We help doctors manage their practices and clinical procedures so they can concentrate on caring for their patients.

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

Job Duties & Responsibilities

• Submits and follow up on credentialing to all contracted commercial payors and government agencies timely and accurately.
• 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.
• Enters and maintains data in the credentialing database, Intellisoft, according to established data entry rules and policies.
• Ensures that demographic changes to contracted physicians are promptly reported to all contracted managed care companies and governments agencies.
• Performs database queries and reports as needed.
• Maintains managed care contract files (paper and electronic) and department databases for contracts and credentialing.

Qualifications

• High School Diploma/GED required.
• Bachelor's degree preferred, but commensurate work experience in progressively responsible administrative positions will be considered.
• 3 – 5 years of experience with physician credentialing and/or physician contracting requirements in a managed care environment.
• 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 to achieve the necessary results required in the credentialing process and support of the Credentialing Department.