Credentialing Specialist

7 days ago


Highlands Ranch, United States OnPoint Medical Group Full time
Credentialing Specialist Job Description

OnPoint Medical Group is seeking a highly organized and detail-oriented Credentialing Specialist to join our team. As a Credentialing Specialist, you will play a critical role in ensuring the accuracy and completeness of provider credentialing information.

Key Responsibilities:
  • Process initial credentialing and recredentialing applications
  • Screen practitioners' applications and supporting documentation to ascertain their eligibility
  • Identify discrepancies in information and conduct follow-ups
  • Maintain internal and external databases (CAQH, PECOS, NPPES)
  • Assist customers with credentialing inquiries
  • Respond to health plan providers' inquiries
  • Responsible for follow-up after submission to ensure that health plans appropriately processed the request and that provider information shows correctly on the health plans website
  • Audit Health Plan Directory
  • CAQH creation and maintenance experience
  • Medicare & Medicaid enrollment and revalidation
  • Perform provider roster reconciliation
  • Initial and reappointment of hospital privileges
Requirements:
  • High school diploma or GED required (Bachelor's Degree preferred)
  • Certified Provider Credentials Specialist (CPCS) preferred
  • Knowledge of Medicare & Medicaid enrollment and revalidation
  • Knowledge of medical credentialing and privileging procedures and standards
  • Excellent verbal and written communication skills
  • Proficient with Microsoft Office Word & Excel (Vlookup)
  • Demonstrate skills in problem-solving analysis and resolution
  • Attention to detail
  • Must be able to function independently and as a team
  • Demonstrate flexibility in multiple project management and strict deadlines
Benefits:
  • Health insurance plan options for you and your dependents
  • Dental, and Vision, for you and your qualified dependents
  • Company Paid life insurance
  • Voluntary options for short-term disability, and long-term disability coverage
  • AFLAC Plans
  • FSA options
  • Eligible for 401(k) after 6 months of employment with a 4% match that vests immediately
  • Paid Time-Off earned

OnPoint Medical Group is an EEO Employer.



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