Credentialing Specialist

We are a privately-owned physician network in the Charlotte, NC Metro Area, operating in the fast-paced, ever-evolving managed care space. Our work is challenging and enjoyable in our family-like atmosphere, with excellent compensation and a competitive benefit package. We offer a 37-hour workweek, most every week.

The Credentialing Specialist coordinates and performs various duties required for processing applications for credentialing applicants and recredentialing existing network providers. In this position, you will work alongside the Director of Credentialing to perform a series of activities leading to a decision to accept or reject a provider's application to participate as a new provider in the network and an existing provider's application to continued participation.

• Sends providers credentialing and recredentialing application packets
• Ensures received application packets contain all required information
• Advises applicants of critical timelines
• Completes electronic logs that track application status and ensures adherence to various deadlines
• Establishes files for all credentialing applicants and recredentialing files for existing network providers
• Conducts credentialing activities and steps within strict predefined timelines
• Maintains knowledge of current payor, agency, and third-party requirements for credentialing providers, including NCQA, URAC, and CMS standards
• Reviews credentialing and recredentialing files to ensure they meet NCQA, URAC, and CMS standards, and payor and company requirements
• Performs primary source verification as required by NCQA, URAC, and/or CMS standards, and/or payor requirements
• Contacts providers to obtain missing or incomplete information for resolution
• Enters provider data in the electronic records database according to established procedures
• Completes verification checklists that document the completion of credentialing tasks and their corresponding timelines
• Prepares files for review by the company's Credentialing Committee
• Notifies providers of credentialing decisions
• Ensures that credentialing is conducted in a nondiscriminatory manner
• Ensures the confidentiality of all information obtained during the credentialing process
• Maintains knowledge of current health plan information and agency requirements for credentialing providers
• Demonstrates and maintains the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA)

• High School Diploma or GED is required
• Bachelor's degree in Business, Healthcare Administration, Communications, or a related field is preferred
• 1-3 years prior office experience in credentialing healthcare providers for a hospital, provider network, or payor
• Competencies: excellent customer service skills, interpersonal skills, communication skills (both oral and written), strong organizational and time management skills, ability to make timely informed decisions, detail-oriented, strong critical thinking skills, ability to handle situations/issues with tact and diplomacy, ability to work well with individuals from diverse backgrounds, ability to maintain confidentiality, adhere to compliance policies, and ensure that all confidential/PHI documents are kept in secure locations, ability to multi-task, prioritize, and adhere to timelines, basic computer skills including MS Office programs

We offer full benefits, including paid medical, dental, vision, and more; plus, paid holidays and paid time off; 401k (with company match); 37-hour workweek (most every week); and a great work environment.