Credentialing Specialist

5 hours ago

White Lake, Michigan, United States Internal Family Medical Office Full time

Job Overview

We are seeking a detail-oriented and organized Credentialing Specialist to join our healthcare team. The ideal candidate will be responsible for managing the credentialing process for healthcare providers, ensuring compliance with industry standards and regulatory requirements. This role offers an opportunity to contribute to the efficiency and integrity of our credentialing operations within a dynamic medical environment. Candidates with experience in managed care, medical office procedures, and familiarity with NCQA standards will excel in this position.

Duties

  • Verify and compile provider credentials, licenses, certifications, and other required documentation
  • Maintain accurate and up-to-date provider files in accordance with organizational policies and regulatory guidelines
  • Coordinate with healthcare providers, insurance companies, and regulatory agencies to facilitate credentialing processes
  • Ensure compliance with managed care requirements and NCQA standards during credentialing activities
  • Review applications for completeness and accuracy before submission
  • Track credentialing deadlines and renewal dates to ensure timely updates
  • Assist in preparing reports related to provider credentialing status and compliance metrics
  • Support audits and quality assurance initiatives related to credentialing documentation

Experience

  • Prior experience working in a medical office or healthcare setting is preferred
  • Knowledge of managed care processes and insurance credentialing procedures is highly desirable
  • Familiarity with medical terminology and healthcare documentation standards
  • Understanding of NCQA standards related to provider credentialing is a plus
  • Strong organizational skills with attention to detail and accuracy
  • Excellent communication skills for coordinating with providers, staff, and external agencies
  • Ability to manage multiple tasks efficiently in a fast-paced environment

This position provides an essential role in maintaining the integrity of our healthcare network by ensuring all providers meet required standards. We seek dedicated professionals committed to accuracy, compliance, and continuous improvement within the credentialing process.

Job Type: Full-time

Pay: From $22.00 per hour

Benefits:

  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Work Location: In person

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