Credentialing Specialist

Job Summary

We are seeking a detail-oriented and organized Credentialing Specialist to join our team. The ideal candidate will be responsible for initiating and maintaining the credentialing process for healthcare providers in an outpatient mental health facility, ensuring compliance with NCQA standards and other regulatory requirements. This role is crucial in maintaining the integrity of our provider network and supporting our commitment to quality care.

• Conduct thorough background checks and verification of credentials for healthcare providers, including education, training, licenses, and certifications.
• Maintain accurate and up-to-date records in the credentialing database, ensuring compliance with all relevant regulations and standards.
• Collaborate with managed care organizations to facilitate the credentialing process and resolve any discrepancies or issues.
• Review and interpret medical terminology to assess qualifications and ensure proper documentation is submitted.
• Prepare reports and documentation for internal audits and external regulatory agencies as needed.
• Stay informed about changes in NCQA standards and industry best practices to ensure ongoing compliance.

• Previous experience in a medical office setting is preferred, providing a strong foundation in healthcare operations.
• Familiarity with managed care processes and regulations is essential.
• Knowledge of medical terminology to accurately assess provider qualifications.
• Understanding of NCQA standards and their application in the credentialing process.
• Strong attention to detail, organizational skills, and the ability to manage multiple tasks effectively.
• Excellent communication skills, both written and verbal, to interact with healthcare providers and internal teams.