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Provider Credentialing Specialist

2 months ago


Saginaw, Michigan, United States Community Care Partners Full time
Job Summary

Community Care Partners is seeking a highly organized and detail-oriented Provider Credentialing Specialist to join our team. As a key member of our administrative staff, you will be responsible for coordinating and maintaining the credentialing and enrollment process for our healthcare providers.

Key Responsibilities
  • Credentialing and Enrollment: Obtain and verify provider information, manage application submissions, and ensure timely processing with all health plans and payors.
  • Provider Support: Communicate with providers to ensure accuracy of applications, gather necessary documentation, and facilitate the onboarding process.
  • Database Management: Update and maintain internal and external databases to ensure provider information is current and accurate.
  • Auditing and Compliance: Assist with audits, ensure compliance with departmental procedures, and maintain necessary reporting and documentation.
  • Vendor Management: Communicate with and manage enrollment vendors to ensure seamless processing.
  • Reporting and Analysis: Run reports and distribute to stakeholders regarding approved providers, licensed professionals, and projected start dates.
Requirements
  • Education: Bachelor's degree preferred; will consider candidates with experience in medical staff services or certified Professional Medical Staff Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) in lieu of degree.
  • Experience: Two years of healthcare experience preferred, such as EDI transaction, credentialing, and Medicare/Medicaid Enrollment or Managed Care Enrollment.
  • Skills: Extensive knowledge of Microsoft Suite, excellent communication and organizational skills, high level of accuracy and attention to detail, ability to multitask and prioritize, and ability to identify and resolve problems in a timely manner.
What We Offer

Community Care Partners is an Equal Opportunity Employer. We offer a competitive hourly rate and a dynamic work environment.