Articularis Healthcare Group, Inc (AHG) is a physician led and owned organization dedicated to improving the healthcare by supporting independent rheumatology practices across the country. As the nation’s largest rheumatology specialty group with 20+ practices across 7 states, AHG provides access to best business practices, advisory and management services, and value-based treatment pathways.

Our Company:

Articularis Healthcare Group is seeking to add an experienced Medical Credentialing Specialist to our Summerville-Administrative location. Our office hours are Monday through Thursday with a 3-day weekend! Enjoy a positive team environment, work/life balance, and robust benefits package including 6 paid holidays, PTO, 401K, group medical, dental, vision, and short & long-term, disability insurance. Please visit our website at www.articularishealthcare.comfor more information.

The Position:

Within the Articularis Healthcare Group the Medical Credentialing Specialist evaluates, analyzes, and coordinates all aspects of the credentialing and recredentialing processes for practitioners practicing within the Articularis Healthcare Group clinical entities. Provides integral support to healthcare operations by enabling timely onboarding of healthcare providers.

The job responsibilities:

• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and University regulations, guidelines, policies, and standards.
• Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards.
• Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; follow credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
• Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
• Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards.
• Communicates clearly with providers, their liaisons, medical staff leadership and Administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
• Ability to make administrative/procedural decisions and judgments.
• Demonstrated advanced working knowledge of Microsoft Word and Excel.
• Advanced skills in computerized spreadsheeting and data

You must have:

• High school diploma or GED; at least 5 years of experience directly related to the duties and responsibilities specified.

Preferred Qualifications:

• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Next Steps:

Once you submit your application, a member of our Talent Acquisition Team will review your resume and application. A team member will reach out to you directly if you are a fit for the position.

EEO/AA-M/F/disabled/protected veteran

*Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Ability to commute/relocate:

• Summerville, SC 29486: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Credentialing: 5 years (Required)

Work Location: In person

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