Job Description
Job Summary
The Credentialing Specialist plays a vital role in ensuring that healthcare providers meet the necessary qualifications and standards to deliver quality care. This position involves managing the credentialing process for medical professionals, ensuring compliance with regulatory standards, and maintaining accurate records. The ideal candidate will possess a strong understanding of managed care, medical terminology, and NCQA standards, along with experience in a medical office setting.
Duties
· Conduct thorough background checks and verification of credentials for healthcare providers.
· Review applications and supporting documentation to ensure compliance with NCQA standards.
· Maintain accurate and up-to-date records of provider credentials in the database.
· Collaborate with various departments to facilitate the credentialing process efficiently.
· Communicate effectively with healthcare providers regarding their credentialing status and requirements.
· Assist in the development and implementation of policies related to credentialing procedures.
· Stay informed about changes in regulations and best practices within managed care.
Requirements
· Minimum of two (2) years’ experience in Payer enrollment or hospital credentialing; knowledgeable with Joint Commission and NCQA credentialing standards; experience with Visual Cactus preferred; good organizational, data entry, and communication skills.
· Proven experience in a medical office setting, preferably within a credentialing or managed care environment.
· Strong knowledge of medical terminology and familiarity with NCQA standards.
· Excellent organizational skills with attention to detail to ensure accuracy in documentation.
· Effective communication skills, both written and verbal, to interact with healthcare professionals and internal teams.
· Ability to manage multiple tasks simultaneously while meeting deadlines.
Proficient in using computer systems for data entry and record management. This position is essential for maintaining high standards of care within our organization, ensuring that all healthcare providers are properly credentialed and compliant with industry regulations.
Company DescriptionThe professional staffing division of EmployBridge, America's Leading Workforce Specialist:
When our Talent is looking for their next opportunity, we know they are not just looking for their next paycheck. Our Recruiters are experts in their specialized fields and understand that making the right match between the candidate and the company, is the key to long term success. We are an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.The professional staffing division of EmployBridge, America's Leading Workforce Specialist:\r\n\r\nWhen our Talent is looking for their next opportunity, we know they are not just looking for their next paycheck. Our Recruiters are experts in their specialized fields and understand that making the right match between the candidate and the company, is the key to long term success.\r\n\r\nWe are an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
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