Credentialing Specialist

The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent recredentialing packages as required by network.

This position is also responsible for maintaining all provider files for network compliance by ensuring all credentialing records comply with regulatory and accrediting standards.

Manage Credentialing /Recredentialing Process

• Data entry of providers into credentialing software
• Roster providers in CAQH
• Work directly with provider/practice to obtain any missing documentation
• Review and ensure credentialing files are complete and accurate from CVO for Director review
• Establish and maintain positive rapport with providers and practices
• Ensures practice addresses are current with health plans, agencies and other entities
• Maintains knowledge of current health plan and agency requirements for credentialing providers
  
  
  

Ongoing Monitoring

• Tracks license, certification, and liability insurance expirations for all providers to ensure timely renewals
• Review monthly State License monitoring via Licensing Board websites
  
  
  

Other

• Participates in weekly team calls
• Assists management in regulatory, accreditation, and health plan audits as requested
• Utilizes and reviews system data for recruitment opportunities
• Performs other related duties as required and assigned
• Minimum 1-2 years credentialing experience in a medical practice
• Knowledge of Credentials Verification Organization (CVO) platforms
• Knowledge of CAQH system and applications
• Knowledge of CMS and NCQA standards
• Proficient with Windows, MS Office, Outlook and Internet Explorer
• Detail oriented with good organizational skills
• Plans and prioritizes to meet deadlines
• Interpersonal skills – inbound & outbound calls to provider/practices is a requirement
• Excellent customer service skills; communicates clearly and effectively
• Works cooperatively in a team atmosphere
  
  
  

Preferred Qualifications

• Certified Provider Credentialing Specialist (CPCS) preferred
  
  
  

This role works out of the office but may be asked to work at home and/or be remote at times. You will need the following when working from home

• Reliable and secure Internet Service Provider at home (no public WiFi) for duration of working hours
• Sufficient room to set up a laptop, monitors, keyboard and mouse
• Comfortable space to work for duration of working hours
• Quiet, private and secure space in which to work
  
  
  

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