Overview
Join our dynamic healthcare team as a Credentialing Specialist, where you will play a vital role in ensuring the accuracy, compliance, and efficiency of provider credentialing processes. This position offers an exciting opportunity to work within a fast-paced environment dedicated to maintaining the highest standards of healthcare accreditation and regulatory compliance. Your expertise will help facilitate seamless provider onboarding, credential verification, and ongoing compliance management, supporting our mission to deliver exceptional patient care through rigorous credentialing practices.
Duties
- Review and verify medical credentialing applications to ensure completeness and accuracy in accordance with healthcare industry standards.
- Manage provider enrollment processes with various medical payers, including Medicare, Medicaid, and private insurance companies, ensuring timely submissions and follow-up.
- Utilize healthcare software applications and databases to track credentialing statuses, update records, and generate reports for internal review.
- Maintain compliance with federal and state healthcare regulations such as CMS (Centers for Medicare & Medicaid Services), JCAHO (Joint Commission), NCQA (National Committee for Quality Assurance), and other accreditation standards.
- Coordinate with healthcare providers, administrative staff, and insurance payers to resolve credentialing issues promptly while handling confidential information with integrity.
- Monitor changes in health regulation policies and update credentialing procedures accordingly to ensure ongoing regulatory adherence.
- Conduct detailed reviews of medical credentialing applications, verifying licensure, certifications, malpractice history, and other credentials in line with healthcare compliance standards.
Skills
- Proven experience with medical credentialing software systems and healthcare databases.
- Excellent understanding of medical terminology, payer enrollment procedures, and regulatory requirements such as CMS guidelines.
- Familiarity with healthcare accreditation standards including JCAHO and NCQA accreditation standards.
- Ability to handle confidential information discreetly while managing multiple tasks efficiently.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook) for documentation and communication purposes.
- Contract management experience within healthcare settings is a plus.
- Exceptional organizational skills combined with attention to detail necessary for reviewing complex credentialing applications.
Join us in this rewarding role where your expertise directly impacts the quality of care delivered by our providers! We are committed to supporting your professional growth through ongoing training on healthcare compliance standards and industry best practices. This paid position offers a vibrant work environment dedicated to excellence in healthcare administration—apply today to become an essential part of our team!
Pay: $50,000.00 - $55,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
