Job Overview
We are seeking a highly motivated Credentialing Specialist to join our team. In this role, you will be responsible for managing the credentialing and privileging processes for anesthesia providers, ensuring compliance with healthcare regulations, payer requirements, and accreditation standards. This position offers an exciting opportunity to contribute to a fast-paced environment where attention to detail and proactive problem-solving are essential.
Responsibilities
- Review and process medical credentialing applications for anesthesia providers, ensuring completeness and accuracy in accordance with healthcare compliance standards.
- Manage provider enrollment with various health insurance payers, including Medicaid, Medicare (Centers for Medicare and Medicaid Services - CMS), and commercial insurers, adhering to all regulatory requirements.
- Utilize healthcare software applications and medical credentialing software to track provider credentials, licensure renewals, certifications, and re-credentialing timelines.
- Conduct thorough verification of provider qualifications, including medical licenses, board certifications, malpractice insurance, and other credentialing documentation.
- Ensure compliance with healthcare industry standards related to confidentiality, data security, and handling of sensitive information.
- Collaborate with administrative teams to facilitate contract management processes and ensure all credentialing activities align with regulatory compliance areas.
Qualifications
- Proven experience in medical credentialing within a healthcare setting.
- Strong understanding of managed care processes, health insurance policies, and payer enrollment procedures.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and healthcare-specific software applications such as medical credentialing software or databases.
- Knowledge of healthcare regulations including CMS guidelines, JCAHO accreditation standards, NCQA standards, and state healthcare regulations.
- Excellent organizational skills with experience managing large databases and tracking multiple provider credentials simultaneously.
- Ability to handle confidential information discreetly while maintaining compliance with healthcare privacy laws.
- Contract management experience in a healthcare environment is a plus.
Benefits Highlight:
- 100% Employer paid health insurance
- Quarterly and yearly bonuses
- Employer funded retirement plan
- Cell phone stipend
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Parental leave
- Retirement plan
- Vision insurance
Work Location: In person
Pay: $21.00 - $25.00 per hour
Expected hours: 38.0 per week
Benefits:
- 401(k)
- AD&D insurance
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Parental leave
- Vision insurance
Work Location: In person
