Credentialing Specialist

• Coordinate provider credentialing process and ensure credentialing deadlines are met.

• Research and solve credentialing/re-credentialing delays & issues with enrollment

• Manage confidential information of internal staff

• Ensure demographic updates are reviewed and verified

• Ensure the database is kept accurate and updated.

• Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re-credentialing

• Prepare documents for Credentialing Committee review.

• Outreach to provider for information verification and other inquiries

• Provide productivity and issues reports for Management.

• Remain current on policies affecting provider credentials and enrollment

• Other duties as assigned.

QUALIFICATIONS:

• Associates/Bachelor's Degree, and/or equivalent work experience.

• A minimum of three (3+) years of credentialing experience.

• Certified Provider Credentialing Specialist, preferred.

• Credentialing in a Healthplan setting, preferred.

• Microsoft Office Suite proficient

• Highly organized.

• Able to multitask efficiently and effectively.

• Solid problem solving and time management skills.

Additional Salary Detail

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).