Credentialing Specialist

Job details You can be the one who makes a difference for millions of members. Our organization is transforming the health of our communities, one person at a time. As a diversified, national healthcare leader, we provide access to competitive benefits and a fresh perspective on workplace flexibility.
... In this role, you will assist the health plan in the meticulous process of credentialing and re-credentialing healthcare providers. You will ensure that every physician, facility, and pharmacy in our network meets the highest standards of safety and professional excellence.

Responsibilities:
Credentialing & Re-credentialing: Perform primary source verification and process applications for various providers (physicians, facilities, and ancillary providers) according to plan specifications and NCQA standards.

Data Management: Maintain and update the provider credentialing database to ensure all information is current, accurate, and audit-ready.

Committee Support: Gather and prepare necessary documentation for Credentialing Committee meetings and assist in the coordination of these sessions.

Compliance: Monitor expiring licenses, DEA certifications, and malpractice insurance, proactively initiating the renewal process to prevent disruptions in service.

Inquiry Resolution: Act as a point of contact for internal and external customers regarding credentialing status, providing professional and timely responses.

Reporting: Generate and utilize reports to track application progress and support business functions within a fast-paced production environment.

Working hours: 8:00 AM - 5:00 PM

Skills:
Advanced Software: Experience with credentialing systems

Professional Certification Preferred but not Required: CPCS (Certified Provider Credentialing Specialist) or CPMSM designation.

Audit Experience: Prior experience preparing files for state or federal audits.

Risk Management: Ability to identify "red flags" in provider work histories or malpractice logs.

Education:
High School

Experience:
1-4 years

Qualifications:
Credentialing Expertise: 1-2+ years of experience in healthcare credentialing, provider data, or medical billing/claims.

Regulatory Knowledge: Solid understanding of NCQA or CMS credentialing standards.

Verification Skills: Experience performing Primary Source Verification (PSV) via NPDB, OIG, and state boards.

Technical Tools: Proficiency in Microsoft Excel (data tracking) and the CAQH portal.

Accuracy: High-speed data entry with a "first-time right" mindset to prevent claims denials.


If you have the experience and are interested Apply today and call !Show lessShow more You can be the one who makes a difference for millions of members. Our organization is transforming the health of our communities, one person at a time. As a diversified, national healthcare leader, we provide access to competitive benefits and a fresh perspective on workplace flexibility.

In this role, you will assist the health plan in the meticulous process of credentialing and re-credentialing healthcare providers. You will ensure that every physician, facility, and pharmacy in our network meets the highest standards of safety and professional excellence.

Responsibilities:
Credentialing & Re-credentialing: Perform primary source verification and process applications for various providers (physicians, facilities, and ancillary providers) according to plan specifications and NCQA standards.

Data Management: Maintain and update the provider credentialing database to ensure all information is current, accurate, and audit-ready.

Committee Support: Gather and prepare necessary documentation for Credentialing Committee meetings and assist in the coordination of these sessions.
... Compliance: Monitor expiring licenses, DEA certifications, and malpractice insurance, proactively initiating the renewal process to prevent disruptions in service.

Inquiry Resolution: Act as a point of contact for internal and external customers regarding credentialing status, providing professional and timely responses.

Reporting: Generate and utilize reports to track application progress and support business functions within a fast-paced production environment.

Working hours: 8:00 AM - 5:00 PM

Skills:
Advanced Software: Experience with credentialing systems

Professional Certification Preferred but not Required: CPCS (Certified Provider Credentialing Specialist) or CPMSM designation.

Audit Experience: Prior experience preparing files for state or federal audits.

Risk Management: Ability to identify "red flags" in provider work histories or malpractice logs.

Education:
High School

Experience:
1-4 years

Qualifications:
Credentialing Expertise: 1-2+ years of experience in healthcare credentialing, provider data, or medical billing/claims.

Regulatory Knowledge: Solid understanding of NCQA or CMS credentialing standards.

Verification Skills: Experience performing Primary Source Verification (PSV) via NPDB, OIG, and state boards.

Technical Tools: Proficiency in Microsoft Excel (data tracking) and the CAQH portal.

Accuracy: High-speed data entry with a "first-time right" mindset to prevent claims denials.


If you have the experience and are interested Apply today and call !Show lessShow more

• key responsibilities

  Credentialing & Re-credentialing: Perform primary source verification and process applications for various providers (physicians, facilities, and ancillary providers) according to plan specifications and NCQA standards.Data Management: Maintain and update the provider credentialing database to ensure all information is current, accurate, and audit-ready.Committee Support: Gather and prepare necessary documentation for Credentialing Committee meetings and assist in the coordination of these sessions.Compliance: Monitor expiring licenses, DEA certifications, and malpractice insurance, proactively initiating the renewal process to prevent disruptions in service.Inquiry Resolution: Act as a point of contact for internal and external customers regarding credentialing status, providing professional and timely responses.Reporting: Generate and utilize reports to track application progress and support business functions within a fast-paced production environment.

• experience

  1-4 years

• skills

  Advanced Software: Experience with credentialing systems Professional Certification Preferred but not Required: CPCS (Certified Provider Credentialing Specialist) or CPMSM designation.Audit Experience: Prior experience preparing files for state or federal audits.Risk Management: Ability to identify "red flags" in provider work histories or malpractice logs.

• qualifications

  Credentialing Expertise: 1-2+ years of experience in healthcare credentialing, provider data, or medical billing/claims.Regulatory Knowledge: Solid understanding of NCQA or CMS credentialing standards.Verification Skills: Experience performing Primary Source Verification (PSV) via NPDB, OIG, and state boards.Technical Tools: Proficiency in Microsoft Excel (data tracking) and the CAQH portal.Accuracy: High-speed data entry with a "first-time right" mindset to prevent claims denials.

• education

  High School

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