Job Summary
We are seeking a highly organized and detail-oriented Credentialing Specialist to join our healthcare team. In this vital role, you will manage the credentialing and re-credentialing processes for healthcare providers, ensuring compliance with all relevant regulations and standards. Your expertise will help maintain the integrity of provider information, support regulatory adherence, and facilitate smooth provider onboarding and ongoing verification. This position offers an exciting opportunity to contribute to a compliant, efficient, and quality-focused healthcare environment.
Duties
- Review and verify provider credentials in accordance with healthcare industry standards and regulatory requirements.
- Maintain accurate and up-to-date provider records within healthcare software applications and databases.
- Ensure compliance with state healthcare regulations, Centers for Medicare and Medicaid Services (CMS) guidelines, NCQA standards, and JCAHO accreditation requirements.
- Coordinate with providers to collect necessary documentation for credentialing, re-credentialing, and privileging processes.
- Manage contract documentation related to provider agreements, ensuring all contractual obligations are met in line with healthcare regulations.
- Monitor credentialing timelines to ensure timely completion of re-credentialing activities and renewals.
- Collaborate with managed care organizations and other external entities to verify provider credentials and maintain compliance with CMS regulatory standards.
Skills
- Strong knowledge of managed care policies, health insurance procedures, and health regulation policies.
- Proficiency in healthcare software applications and database management systems used for credentialing purposes.
- Excellent understanding of medical terminology, medical office workflows, and healthcare documentation standards.
- Familiarity with CMS regulations, NCQA accreditation standards, JCAHO requirements, and state healthcare laws.
- Experience managing contracts within a healthcare setting to ensure compliance with legal and regulatory frameworks.
- Ability to interpret complex health regulation policies and apply them accurately in daily tasks.
- Exceptional organizational skills with keen attention to detail to manage multiple credentialing files efficiently.
Join us in ensuring our healthcare providers meet the highest standards of quality and compliance! This role is perfect for driven professionals eager to make a meaningful impact on healthcare delivery through meticulous credentialing practices.
Pay: $20.00 - $25.00 per hour
Benefits:
- 401(k)
- 403(b)
- AD&D insurance
- Dental insurance
- Employee assistance program
- Employee discount
- Free parking
- Health insurance
- Life insurance
- Paid time off
- Parental leave
- Referral program
- Retirement plan
- Vision insurance
Work Location: In person
