Westcancercenter

Credentialing Specialist - Full Time - Germantown, TN

Germantown, TN · Full-time

Sponsorship not specifiedDetected 8 days ago

ExcelEHR/EMRResearchLeadershipCommunicationOrganizational SkillsMicrosoft Office

About the role

At West Cancer Center, we are committed to providing exceptional, patient-centered cancer care through collaboration, innovation, and operational excellence. Our Credentialing team plays a critical role in ensuring our providers are properly credentialed, licensed, and enrolled so they can deliver the highest quality care to our patients.
The Credentialing Specialist is responsible for maintaining active credentialing status for all providers by completing initial and ongoing credentialing, privileging, licensing, and enrollment requirements for hospitals, surgery centers, and commercial and government payers. This role maintains provider information across multiple credentialing databases,

Maintain current and accurate provider information in external credentialing databases and the MD-Staff credentialing system, including CAQH Universal Data Source
Manage MD-Staff workflows, application progress, and checklist completion
Maintain knowledge of current payer and agency credentialing requirements
Create, schedule, and generate ad hoc queries and reports within the MD-Staff system for credentialing and enrollment requests
Collaborate with the Revenue Cycle team and billing staff to resolve credentialing-related denials and authorization issues
Maintain confidentiality of provider information
Perform all other duties as assigned

Ability to organize and prioritize work while managing multiple priorities
Ability to research and analyze information
Ability to work independently with minimal supervision
Proficiency in Microsoft Office applications, including Word, Excel, and Access, as well as internet-based resources

Three (3) or more years of credentialing experience
Typical office environment
Frequent use of computers and credentialing software systems
Ability to sit, stand, walk, and use hands and wrists for extended periods
Ability to communicate effectively in person, by telephone, and in writing
Ability to organize, review, and maintain detailed documentation with a high degree of accuracy

Complete and submit initial Tennessee, Mississippi, and Arkansas medical license applications and required supporting documentation
Monitor expiration dates for state medical licenses, DEA registrations, life support certifications, and board certifications to ensure timely renewals
Maintain current copies of state licenses, board certifications, DEA certificates, malpractice coverage, protocols for allied health providers, and other required credentialing documents
Monitor health plan enrollment processes using MD-Staff workflows and checklists
Audit health plan directories to ensure accurate provider information
Comprehensive benefits package.
Ensure practice location information remains current with health plans, agencies, and other credentialing entities

Complete provider credentialing and recredentialing applications, monitor application status, and follow up on outstanding items
Generate MD-App portals for new providers, assist providers with portal-related questions, verify application accuracy, and upload information into the MD-Staff credentialing system
Coordinate provider enrollment and status changes with the group's malpractice carrier (SVMIC)
Provide all required documentation to SVMIC to facilitate timely provider enrollment
Ensure physicians complete annual SVMIC CME risk management requirements
Assist the Finance Department with questions related to SVMIC statements

This listing is sourced directly from Westcancercenter's careers page and normalized into a canonical job model.