Delegated Credentialing Specialist, Temp

Overview

Credentialing Specialist is responsible for credentialing and recredentialing client practitioners, and ensuring enrollment with participating client health plans.

• Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for payor enrollment and credential verification process.
• Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s).
• Enroll providers with client payors to include Medicare, Medicaid and state and federal commercial health plans and follow up as required until process complete.
• Update CAQH and NPI information consistent with client practice information.
• Gather, verify, evaluate highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standards.
• Respond to all practitioner, client health plan and internal inquiries in a timely manner.
• Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed timeframe.
• Maintain practitioner paper and electronic data files for clients; utilizing CAQH to submit practitioner data as required to credential individual practitioners.
• Collaborate with participating clients in a professional manner, department manager and/or external agencies to facilitate and ensure smooth hand‑off during the credentialing process.
• Follow up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process.
• Perform all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner files.
• Conduct sanctions and compliance monitoring and alert Manager of any undisclosed negative findings immediately.
• Participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.
• Contribute to positive culture.
• Keep Manager informed of potential credentialing or enrollment issues.

• Proficient using payor websites including but not limited to CAQH, Pecos, NPI/NPPES, Availity, Navi Net, CMS I&A.
• Proficient with various software used for provider applications, verifying credentials and tracking verification statuses.
• Proficient with payor enrollment process for all levels of licensure including but not limited to MD/DO, NP, PhD, PT, OT, LCSW, OD, DDS, DPM, etc. across all specialties including medical, dental, vision, behavioral health and physical health.
• Knowledge of primary source verification--understand the process of verifying information directly from the original/authorized source that meets relevant regulations, accreditation requirements and compliance standards.
• Experience:
  
  3-5 years of responsibility for medical credentialing processes, policies and procedures and delegated credentialing requirements.
• Ability to communicate clearly and concisely, both verbally and in written correspondence.
• Ability to work well under tight deadlines and respond to rapidly changing demands and provide efficient follow up.
• Detail oriented with ability to recognize vital information from credentialing documents.
• Demonstrate problem‑solving, critical thinking, and deductive reasoning skills.
• Ability to consistently maintain quality and production expectations.
• Ability to learn and use credentialing database and other related databases.
• Comfortable dealing with sensitive and confidential information with discretion and trust.
• Proficiency with MS Office suite.
• Associate’s degree or an equivalent combination of education and/or experience.
• Minimum of 3 years’ experience in provider credentialing in a healthcare setting.
• Certified Provider Credentialing Specialist (CPCS) preferred.
• Provider Enrollment Specialist Certificate (PESC) preferred.

Pay: $25.00/hour

• Competitive pay
• Flexible work schedules, including work from home options available
• Award‑winning training and development programs

We welcome applicants of any race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, and individuals with disabilities as an affirmative action/equal opportunity employer. We are an at‑will employer.