Credentialing Specialist

2 weeks ago


Chicago, Illinois, United States Humboldt Park Health Full time
Position Overview:

The Credentialing Specialist plays a crucial role in overseeing, coordinating, and sustaining the credentialing and re-credentialing processes for all healthcare providers within the Humboldt Park Health network. This position ensures adherence to the standards set by relevant accrediting and regulatory bodies while maintaining a comprehensive understanding of the laws and regulations governing credentialing practices. The specialist is accountable for the precision and reliability of the credentialing database and associated systems.

Key Responsibilities:
  • Oversees and coordinates the evaluation and processing of practitioner applications and related documentation to guarantee thorough credentialing for all healthcare payers.
  • Identifies and addresses issues within provider applications that necessitate further investigation, validates inconsistencies, and ensures proper follow-up actions are taken.
  • Prepares and submits the Universal Provider roster template to all contracted payers on a monthly basis, following the established submission protocols.
  • Handles inquiries from other healthcare entities and collaborates with both internal and external stakeholders regarding day-to-day credentialing matters.
  • Conducts data entry into the Quick Cap v7 credentialing module, ensuring that provider demographic information is accurately captured using the CAQH credentialing database, thereby enhancing efficiency and accuracy.
  • Monitors and tracks credentialing statuses with all payers for all providers using the Quick Cap v7 credentialing module, providing updates via email as necessary to clarify any delays.
  • Delivers weekly updates to clinics and business offices to keep all parties informed about the credentialing statuses of providers.
Qualifications:
  • High School Diploma or Equivalent
  • 1 to 3 years of relevant experience in credentialing or a related field


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