Credentialing Specialist

2 weeks ago

Frisco, United States Careington International Corp Full time

Careington International Corporation is a solutions-oriented company. An established leader, we have been a trailblazer in the field of discount health care since 1979. Over the years, our mission has remained the same, to create discount health programs that are marketable to the employer, profitable to the provider and economical for the member. In response to a growing demand for our products and services in recent years, our growth means that we continuously strive to recruit innovators to join our fast-paced, forward-thinking team.

Careington International is looking to add a new team member to our Network Development team. This is a fulltime, hybrid position that will be worked Monday-Friday from 8:00am CST to 5:00pm CST with office attendance required Tuesday through Thursday.

The Credentialing Specialist is responsible for managing the credentialing and re-credentialing process for dentist, physicians and counselors, ensuring compliance with applicable regulations and Careington standards. This role ensures that providers meet the required qualifications, licensure, and certifications to deliver care within Careington's networks.

Duties and Responsibilities:

  • Credentialing & Re-Credentialing:
    • Collect and verify credentials for providers including but not limited to licensure, certifications, malpractice insurance, education, and work history.
    • Manage the timely and accurate completion of initial credentialing and re-credentialing applications.
    • Ensure all documentation meets legal and Careington requirements for credentialing.
    • Ensure compliance with state, federal, and accrediting bodies' standards such as CMS, NCQA, URAC, and others.
    • Assist with other departmental projects.
  • Primary Source Verification:
    • Conduct primary source verification (PSV) including but not limited to appropriate licensure, board certifications, malpractice claims, education.
    • Utilize online databases and resources (e.g., CAQH, NPPES, AMA, etc.) for verification purposes.
  • Provider Data Management:
    • Maintain accurate provider records and databases, updating information regularly as per credentialing requirements.
    • Ensure that provider profiles are complete, including all required documents and current credentials.
  • Communication:
    • Serve as a point of contact for providers regarding credentialing status, document requests, and issues related to credentialing.
    • Maintain professional communication with providers to ensure that their applications and re-credentialing are processed efficiently.
  • Problem Resolution:
    • Address and resolve discrepancies or issues related to provider credentials, ensuring timely solutions are provided to maintain compliance and prevent delays in provider participation.
  • Team Support:
    • Collaborate with team members and other departments to ensure smooth and efficient credentialing operations.
Required Skills and Qualifications:
  • Education: College degree preferred but not required
  • Experience: 1 to 2 years of experience in healthcare credentialing or a related administrative field.
  • Attention to Detail: Ability to manage and verify a high volume of detailed provider information, ensuring accuracy and compliance with standards.
  • Communication: Strong verbal and written communication skills with the ability to interact professionally with healthcare providers and internal staff.
  • Organizational Skills: Excellent time management and organizational skills to handle multiple credentialing processes simultaneously and meet deadlines.
  • Technical Skills: Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
  • Problem Solving: Strong analytical skills to identify and resolve credentialing issues quickly.
  • Confidentiality: Ability to handle sensitive provider information in compliance with privacy regulations.


Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

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