Credentialing Operations Specialist
4 weeks ago
Remote Work Opportunities:
We provide remote work options across various states.
Job Overview:
The Credentialing Operations Specialist plays a vital role in the Credentialing Department by ensuring the accuracy and timeliness of provider information. This includes managing updates, modifications, additions, and terminations of provider credentials while adhering to established timelines and quality standards.
Key Responsibilities:
1. Conduct primary source verifications and communicate with providers to gather missing information, ensuring the integrity of provider data across all systems.
2. Enter initial data for potential network providers into the credentialing system.
3. Review provider applications for compliance with credentialing criteria and follow up to secure any missing documentation promptly.
4. Verify provider credentials and qualifications through primary sources as necessary.
5. Prepare files for review by the Credentialing Committee and maintain current status information in the provider credentialing database.
6. Represent the Credentialing Unit at committee meetings as required.
Qualifications:
Required:
- High School Diploma or GED.
- U.S. Citizenship.
- Minimum of 6 months of experience in provider credentialing.
Preferred:
- Over 1 year of credentialing experience.
- Familiarity with provider credentialing software or data management systems.
- Knowledge of URAC or NCQA standards.
Competencies:
- Commitment to Task: Demonstrates adherence to policies and procedures with high motivation.
- Communication Skills: Ability to effectively influence and collaborate with others.
- Technical Proficiency: Competent in using Microsoft Office and credentialing software systems.
Working Conditions:
Ability to work within a standard office environment with minimal travel and extensive computer use.
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