Credentialing Specialist
3 weeks ago
We are seeking a highly organized and detail-oriented Credentialing Specialist to join our team at SAC Health. As a key member of our healthcare team, you will be responsible for maintaining and processing initial applications and reappointments for credentialing and privileging of medical staff and providers.
In this role, you will accurately maintain database information, stay up-to-date with regulatory requirements, and perform routine queries to manage expired items. You will also work closely with health plans, physicians, and administration to ensure seamless communication and efficient enrollment processes.
Key Responsibilities:
- Maintain an ongoing system for processing initial and re-appointment applications for credentialing, billing, and privileging of assigned medical staff and providers.
- Verify and enter accurate data in databases and ensure timely submissions to relevant departments, agencies, boards, and committees.
- Ensure strict confidentiality and maintain current knowledge of legal, state, federal, TJC, NCQA, and other regulatory guidelines for appointment/reappointment processes.
- Prepare required reports for departments, agencies, boards, and committees as necessary; prepare board presentations and meeting follow-up notifications.
- Manage expired items, notify, and process suspensions or reinstatements according to SAC Health policies and procedures.
Requirements:
- High school graduate or equivalent required; BA/BS degree preferred.
- Minimum one (1) year of healthcare credentialing experience.
- CPMSM or CPCS certification preferred.
What We Offer:
- Competitive salary: $65,000 - $85,000 per annum.
- Full benefits package, including PTO accrual, sick leave, paid holidays, and more.
- Opportunities for professional growth and development.
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