Credentialing Specialist

1 week ago


Silver Spring, Maryland, United States Community Clinic Full time
{"Position Summary": "The Credentialing Coordinator will be responsible for credentialing new and established healthcare providers, maintaining provider information, and ensuring compliance with regulatory guidelines. This role requires strong organizational and analytical skills, with attention to detail and excellent communication skills.", "Key Functions & Responsibilities": "
  • Maintain accurate and up-to-date provider databases to ensure compliance with regulatory requirements.
  • Process initial and reappointment credentialing applications, verifying healthcare provider information and licensing.
  • Coordinate with medical staff personnel to ensure contract providers and allied health professionals are properly licensed and credentialed.
  • Track provider certifications, licensure expiration dates, and other expirable documentation to ensure ongoing compliance with regulatory standards.
  • Establish and maintain data entry in Credentialing for Affordable Quality Healthcare (CAQH).
  • Maintain good rapport and professional communication with Health Plan Representatives.
  • Support provider enrollment staff with Medicare, Medicaid, and commercial insurances for Maryland.
  • Communicate with healthcare providers and external agencies regarding licensing and credentialing requirements.
", "Minimum Qualifications": "
  • High school diploma or equivalent required.
  • Experience with state, federal, and accreditation entity regulations and requirements related to credentialing and privileges.
  • Certification in Medical Staff Services (CMSS) or Certified Provider Credentialing Specialist (CPCS) preferred.
  • Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances.
  • Minimum of 3 years' experience in credentialing and provider enrollment at a healthcare facility; experience in a Federally Qualified Health Center preferred.
  • Ability to prioritize tasks and work independently.
  • Excellent verbal and written communication skills.
  • Strong organizational and analytical skills, with attention to detail.
", "Why Work at CCI?": "
  • Extensive benefits plan.
  • Generous PTO Plan.
  • 403B Retirement Plan + Employer match up to 4%.
  • Tuition Reimbursement.
  • Continuing education assistance; can be used toward obtaining certifications, renewal of certifications, or possible conference attendance.
", "About CCI": "CCI Health Services is a diverse and inclusive workplace grounded in community. Located in the Washington, DC Metro Area, each year CCI cares for more than 60,000 individuals in Montgomery and Prince George's Counties. As a non-profit, CCI is committed to improving health equity through the provision of affordable primary care for all, across all stages of life.", "Language": "en-US"}

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