Job Description
Job Description
Job Description
Description
Job Title: Credentialing Specialist
Department: Operations - Credentialing
We are currently seeking a highly motivated Credentialing Specialist. This role will report to the Supervisor - Credentialing and enable us to continue to scale in the healthcare industry. The Credentialing Specialist fulfills all activities required for successful completion of initial and re-credentialing applications. Key responsibilities include Credentialing Committee preparation and scheduling, responding to health plan credentialing audits, and successful integration of credentialing files for newly acquired entities. This is a hybrid/remote role where the expectation is to work both in office and at home on a weekly basis (dependent on the employee’s location).
What You'll Do
- Process initial and reappointment credentialing applications and conduct follow up as needed
- Quality spot check applications before submission to committee
- Prepare monthly reports for peer review/credentialing committee meetings
- Input all credentialing data into credentialing software database accurately and timely
- Work closely with IPAs and Hospitals to ensure exceptional customer service
- Maintain provider state licenses, DEA certificates, malpractice insurance and any other required credentialing documents
- Represents the MSO while interacting with internal and external contacts
- Remain up to date with credentialing accreditation standards with NCQA and Joint Commission
- Knowledge of current credentialing standards published by Joint Commission and/or NCQA
- Ability to analyze complex application problems and provide solutions • Ability to work with multiple projects and deadlines
- Excellent written and verbal communication skills
- Detail oriented and possess strong organizational skills in a fast-pace environment
Qualifications:
- High School Diploma
- Bachelor’s Degree
- Licensure, Certification, Registration: CPCS or CPMSM certification
- 2-3 years’ credentialing experience within a managed care, hospital or CVO credentialing
Environmental Job Requirements and Working Conditions
- This position is in office with the option to be hybrid or remote (dependent on the employee’s location.
- The office is located at 19500 Hwy 249 Suite 570 Houston, TX 77070.
- The total compensation target pay range for this role is: $20.00 to $25.00 per hour. The salary range represents our national target range for this role.
Job Tags
Hourly pay,