Credentialing Specialist- Onsite

3 weeks ago

BIRMINGHAM, United States Guidehouse Full time

Job Family:

Patient Account Representative Credentials


Travel Required:

None


Clearance Required:

None

What You Will Do:

The Credentialing Specialist is responsible for coordinating, processing, monitoring, and maintaining the initial and reappointment confidential credentialing process for designated providers.  Ensures timeliness and compliance with client standards and compliance as well as all legal and regulatory requirements.  The Credentialing Specialist is responsible for accuracy and integrity of the credentialing database system either client owned or Guidehouse credentialing system.

This position is onsite in Birmingham, AL.

  • Monitor and ensure compliance with company and client standards.

  • Strong understanding of credentialing software software/systems used.

  • Gather, verify, and evaluate healthcare provider credentials for initial and recredentialing applications; identify potential issues; determine if further investigation or information is necessary and make appropriate inquiries; assess completed applications.

  • Responsible for ensuring timely enrollment of new providers with 3rd party and government payers; and maintenance of existing active physicians and advanced practice providers. Also, accountable for submitting termination requests to all health plans in a timely manner. Enter and maintain data in the credentialing database according to established data entry rules, policies, and procedures. Assists with maintaining the expirable tracking system.

  • Maintain credentials files and related records according to established policies and procedures. Processes application requests from contracted entities; ensures correct application forms and complete packets are sent to provider; maintains tracking mechanisms.

  • Updating of spreadsheets, monitoring outstanding items for each client, and providing updates to leadership, client, and team

  • All job-related duties as assigned.

  • Strong verbal and written communication skills to effectively communicate with staff and client

  • Problem solving and critical thinking skills.

  • Demonstrated proficiency researching credentialing guidelines.

  • Detailed oriented with demonstrated accuracy, organizational and time management skills.

  • Ability to multitask and work independently.


What You Will Need:

  • High School Diploma or equivalent

  • 1-3 years of prior relevant experience- provider enrollment and or billing



What Would Be Nice To Have:

  • Knowledge of medical terminology preferred

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What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

  • Medical, Rx, Dental & Vision Insurance

  • Personal and Family Sick Time & Company Paid Holidays

  • Position may be eligible for a discretionary variable incentive bonus

  • Parental Leave

  • 401(k) Retirement Plan

  • Basic Life & Supplemental Life

  • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

  • Short-Term & Long-Term Disability

  • Tuition Reimbursement, Personal Development & Learning Opportunities

  • Skills Development & Certifications

  • Employee Referral Program

  • Corporate Sponsored Events & Community Outreach

  • Emergency Back-Up Childcare Program

About Guidehouse
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.


Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.


If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.


Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

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