Credentialing Specialist

• →Verify the credentials, licensure, certifications, and qualifications of medical and healthcare professionals, and ensure compliance with relevant regulations and industry standards
• →Conduct thorough checks of educational background, training, licensure, certification, and work experience of healthcare providers and ensure the accuracy of completeness
• →Maintain records of all credentialing activities, including updated information on licenses, certifications, and malpractice insurance
• →Ensure that all healthcare providers comply with state and federal regulations, as well as industry standards and organizational policies
• →Oversee the re-credentialing process for all health care providers and ensure timely renewal of credentials and certifications, avoiding any lapse in compliance
• →Verify the accuracy of health care provider information, including education, training, experience, and licensure
• →Maintain and update credential files and databases, warranting compliance with current regulations and standards
• →Communicate with healthcare providers, regulatory agencies, and other stakeholders to resolve credentialing issues
• →Coordination between healthcare providers, insurance companies, and regulatory agencies, facilitating timely and accurate exchange of information
• →Prepare and present credential reports to management and relevant committees
• →Assist in preparing for internal and external audits, providing necessary documentation and information to auditors
• →Stay informed about changes in healthcare regulations and credentialing requirements
• →Operate standard office equipment and use required software applications
• →Perform other duties and responsibilities as assigned

Knowledge of:

• Credentialing regulations, policies, and procedures
• Relevant state and federal regulations, as well as standards set by accrediting bodies such as The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA)
• Healthcare regulations and compliance standards
• Proficiency in credentialing software and databases, as well as standard office applications

Skill in:

• Strong attention to detail and organizational skills
• Excellent written and verbal communications and interpersonal skills
• Excellent organizational skills to manage multiple tasks and deadlines effectively
• Operating standard office equipment and using required software applications for program area and other applications, including Microsoft Office

Ability to:

• Manage multiple deadlines
• Mutti task and able to negotiate and coordinate between multiple entitles in order to solve a issues
• Be patient, self-control and provide a solution to issues
• Build positive relationships with healthcare providers
• Demonstrate a high degree of trust and confidentiality
• Work independently

• Minimum Degree Required:

• Bachelor’s degree

• Required Disciplines:
  • Healthcare Administration, Business Administration, or a related field

~and~

• 3 to 5 years’ experience or any equivalent combination of experience, education and/or training approved by Human Resources

• Licenses/Certifications Required at Date of Hire:
  • (CPCS), Certified Provider Credentialing Specialist is strongly preferred

Hours: Normal business hours, some additional hours may be required

Travel Required: None generally required; Local, in-state, national, and international travel, up to 10%

Working Environment: Climate controlled office