Credentialing Specialist
2 months ago
Job Title: Credentialing Specialist (Hybrid)
Client: Health Care Insurance
Duration: 6 Months
Location: Baltimore, MD 21224
Top 5 Required Skills:
- Proficient in Excel
- Credentialing Knowledge
- Customer Service skills
- Written Communication skills
Purpose:
- Credential practitioners for network participation with Client. Maintain provider data to ensure compliance with regulatory, accreditation, legal, and company requirements.
Essential Functions:
- 40% Analyze credentialing applications to verify credentials for Client network participation. Determine appropriate networks and obtain executed contracts.
- 30% Respond to inquiries regarding provider eligibility, credentialing, status, and updates. Ensure timely resolution and proactive measures.
- 15% Maintain provider files, update information during credentialing, recredentialing, and other maintenance activities.
- 10% Identify, analyze, and resolve provider file issues. Verify data and ensure successful system integration.
- 5% Prepare written responses and communicate effectively to obtain missing information.
Qualifications:
- Education Level: High School Diploma
- Experience:
- 3 years in physician credentialing or health insurance/managed care operations
- Customer service, claims, billing and enrollment, or call center experience
Preferred Qualifications:
- Bachelor's Degree in Business, Healthcare Administration, or related field
Knowledge, Skills, and Abilities (KSAs):
- Proficient in Excel, including Pivot tables
- Excellent verbal and written communication and interpersonal skills
- Ability to develop and maintain effective relationships
- Knowledge of medical terminology
- Proficiency in using reference materials and following SOPs
- Understanding of jurisdictional requirements and legal ramifications
Licenses/Certifications:
- Certified Provider Credentialing Specialist (CPCS) Preferred
#ZR
Company DescriptionAs a leading contract, contract-to-hire and professional placement firm, Three Point Solution understands the importance of aligning our client with the right resource at the right time. We are committed to the highest caliber of service that will benefit our clients, candidates and employees. Unlike large, corporate style recruiting firms, we commit to individualized attention that uniquely positions us to bridge the communication gap between recruiter, employer and candidate. Our goal is to cultivate and maintain true partnerships with our clients and candidates.Company DescriptionAs a leading contract, contract-to-hire and professional placement firm, Three Point Solution understands the importance of aligning our client with the right resource at the right time. We are committed to the highest caliber of service that will benefit our clients, candidates and employees. Unlike large, corporate style recruiting firms, we commit to individualized attention that uniquely positions us to bridge the communication gap between recruiter, employer and candidate. Our goal is to cultivate and maintain true partnerships with our clients and candidates.-
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