Credentialing Specialist

5 days ago

Fort Lauderdale, Florida, United States TEKsystems Full time
Credentialing Specialist Job Description

We are seeking a skilled Credentialing Specialist to join our team at TEKsystems. As a Credentialing Specialist, you will play a critical role in ensuring the accuracy and completeness of provider credentialing data.

Key Responsibilities:
  • Process and Track Credentialing Applications: You will be responsible for processing and tracking credentialing applications within established policies and procedures, while maintaining and updating the credentialing database.
  • Provider Credentialing and Re-Credentialing: You will provide credentialing and re-credentialing to various providers, including physicians, healthcare delivery organizations, or pharmacies, according to specifications.
  • Customer Inquiries: You will respond to internal and external customer inquiries regarding credentialing status.
  • Primary Source Verification: You will track and follow up with Provider Primary Source Verification (PSV) and coordinate with the Credentialing Verification Organization (CVO).
  • Credentialing Committee Preparation: You will assist with the preparation and coordination of the Credentialing Committee.
  • Credentialing Delegation Audits: You will participate in credentialing delegation audits, as requested by the Manager, with selected provider groups and subcontracted vendors.
  • Regulatory Compliance: You will ensure strict compliance with regulatory bodies, including Joint Commission, NCQA, URAC, CMS, AAHC, Medicaid, and Medicare.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

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