Credentialing Specialist

4 weeks ago


Detroit, United States Morgan Stephens Full time
Job Title: Provider Credentialing Specialist (Temporary to Perm)

Healthcare Experience REQUIRED

Fully Remote - Candidate must live in Michigan

Location: Remote (8AM-5PM EST)

Experience Required: 1+ Year of Provider Credentialing or Similar Experience

Top Skills (Must Have): Proficiency in MS Office, especially Excel; Self-starter and motivated

Summary:

As a Provider Credentialing Specialist, you will be responsible for overseeing the credentialing and primary source verification processes for practitioners and healthcare organizations. Your role will involve coordinating all aspects of the credentialing process in accordance with organizational policies and procedures.

Essential Functions:

Processing Specialist:
  • Process initial and recredentialing applications from providers, ensuring compliance with departmental requirements.
  • Accurately enter application data, conducting reviews for errors before submitting provider files for quality review, meeting departmental requirements.
  • Process a minimum number of provider applications each month, adhering to departmental requirements.
Recredentialing/Termination Specialist:
  • Prepare and distribute recredentialing groups, meeting departmental requirements.
  • Complete 1st, 2nd, and 3rd requests for recredentialing packets, as per departmental requirements.
  • Generate reports for various state plans/departments to identify providers who have not returned their recredentialing applications or are past due for credentialing, adhering to departmental requirements.
Ongoing Monitoring/Watch Follow-up Specialist:
  • Perform follow-up for provider files on "watch" status, as required by departmental guidelines.
  • Ensure timely follow-up for ongoing state license action monitoring reports.
  • Ensure timely follow-up for ongoing Medicare/Medicaid sanctions monitoring reports.
Delegation Specialist:
  • Maintain the minimum volume of delegated provider entries in CACTUS to meet productivity expectations, in line with departmental requirements.
  • Update delegate information received from delegate groups within the required timeframes, complying with departmental requirements.
Knowledge/Skills/Abilities:
  • Proficiency in multitasking and efficient time management.
  • Strong written and verbal communication skills.
  • Competency in computer usage and data entry.
  • Familiarity with NCQA, CMS,credentialing criteria.
  • Ability to adapt professionally to a dynamic and evolving environment and rule set.
  • Excellent verbal and written communication skills.
  • Punctuality and attendance to support the required quality and quantity of work.
  • Maintenance of confidentiality and compliance with the Health Insurance Portability and Accountability Act (HIPAA).
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers.

Required Education: High School Diploma or equivalent

Required Experience: 1+ year of relevant experience

  • Detroit, United States Honigman LLP Full time

    Honigman is a premier business law firm, based in Michigan with an international practice. Recently recognized in Michigan as one of the 101 Best and Brightest Places to Work, we earned this recognition by recruiting attorneys and staff members with outstanding credentials. Currently, we are looking for an entry-level Conflicts and New Business Specialist in...


  • Detroit, United States Honigman LLP Full time

    Honigman is a premier business law firm, based in Michigan with an international practice. Recently recognized in Michigan as one of the 101 Best and Brightest Places to Work, we earned this recognition by recruiting attorneys and staff members with outstanding credentials. Currently, we are looking for an entry-level Conflicts and New Business Specialist in...

  • Program Specialist

    2 weeks ago


    Detroit, Michigan, United States Veterans Affairs, Veterans Health Administration Full time

    Summary The incumbent serves as the Program Specialist for Nursing Services which has several service lines which require support (GEC, Medicine, Mental Health, Specialty Services, Integrated Services, Women's Clinic and Professional Practice). The purpose of the position is to direct and perform all administrative functions for the assigned service(s)....


  • Detroit, Michigan, United States Naval Education and Training Command Full time

    Summary You will serve as a EDUCATION SERVICES SPECIALIST of NAV RECRUITING DISTRICT MICHIGAN. Responsibilities You will establish liaison with education officials and employment representatives to raise awareness of Navy occupational programs and to promote the Navy as a career option for the civilian community. You will facilitate recruiter access to high...


  • Detroit, United States Medtronic Inc. Full time

    Bring your talents to a leader in medical technology and healthcare solutions. Rooted in our long history of mission-driven innovation, our medical technologies open doors. We support your growth with the training, mentorship, and guidance you need to own your future success. Join us for a career that changes lives. POSITION DESCRIPTION: The Vascular...


  • Detroit, Michigan, United States Veterans Affairs, Veterans Health Administration Full time

    Summary The CPS is a fully license pharmacist that is eligible for credentialing as a licensed independent provider with prescribing privileges as outlined in their individual scope of practice. The primary responsibility of the CPS is the provision of evidence-based pharmaceutical care services through care of patients and consultation with other providers...


  • Detroit, United States Abbott Laboratories Full time

    About AbbottAbbott is a global healthcare leader, creating breakthrough science to improve people’s health. We’re always looking towards the future, anticipating changes in medical science and technology.Working at AbbottAt Abbott, you can do work that matters, grow, and learn, care for yourself and family, be your true self and live a full life....


  • Detroit, United States Ascension Health Full time

    Details * Sign-on bonus: $7,500.00 * Department: Interventional Radiology * Schedule: FT 40 hours per week, 5 days per week, 8 hour day shift with on call obligations * Hospital: Ascension St. John Hospital * Location: Detroit, MI Sign-on bonus available based on eligibility. Benefits Paid time off (PTO) Various health insurance options & wellness...


  • Detroit, United States Detroit Wayne Mental Health Authority Full time

    Job DescriptionJob DescriptionUnder the general supervision of the Director of Quality Improvement, the Performance Improvement and Performance Monitor staff is responsible for conducting on-site provider reviews and ensuring compliance of assigned providers to federal, state, local, contractual, regulatory, and best practice standards and guidelines....


  • Detroit, United States Detroit Wayne Mental Health Authority Full time

    Job DescriptionJob DescriptionUnder the general supervision of the Director of Quality Improvement, the Performance Improvement and Performance Monitor staff is responsible for conducting on-site provider reviews and ensuring compliance of assigned providers to federal, state, local, contractual, regulatory, and best practice standards and guidelines....


  • Detroit, United States Detroit Wayne Integrated Health Network Full time

    Under the general supervision of the Director of Quality Improvement, the Performance Improvement and Performance Monitor staff is responsible for conducting on-site provider reviews and ensuring compliance of assigned providers to federal, state, local, contractual, regulatory, and best practice standards and guidelines. PRINCIPAL DUTIES AND...


  • Detroit, United States Detroit Wayne Mental Health Authority Full time

    Under the general supervision of the Director of Quality Improvement, the Performance Improvement and Performance Monitor staff is responsible for conducting on-site provider reviews and ensuring compliance of assigned providers to federal, state, local, contractual, regulatory, and best practice standards and guidelines. PRINCIPAL DUTIES AND...

  • Locum Physician

    10 hours ago


    Detroit, United States LocumJobsOnline Full time

    LocumJobsOnline is working with Weatherby Healthcare to find a qualified Pediatrics MD in Grand Rapids, Michigan, 49503!About The PositionWeatherby can help you build a custom career plan, with multiple positions available for you today. Call us for specific details on your future job today.Willing to wait for licenseBC or BE requiredCall, Weekend...


  • Detroit, United States TeamHealth Full time

    Want to make great money, have your travel paid and enjoy your blocked time off? TeamHealth has an outstanding opportunity to join our elite special operations team! Our concierge travel support makes your travel coordination hassle-free, and our in-house licensing support specialist takes the headache out of obtaining licensure and certifications. We pay...

  • Patent Paralegal

    5 days ago


    Detroit, United States Personnel Management Solutions, Inc. Full time

    Job DescriptionJob DescriptionLaw firm is a premier business law firm with an international practice is looking for a Patent Paralegal. Recently recognized as one of the Best and Brightest Places to Work, they earned this recognition by recruiting attorneys and staff members with outstanding credentials. With more than 300 attorneys working in 60 different...

  • Medical Assistant

    2 weeks ago


    Detroit, United States Concentra Full time

    Overview:Please be advised, if you are viewing this position on Indeed, that the salary rate/range set forth herein was provided by Indeed. Concentra's market specific rate/range will be provided during the interview process.Do you want to apply your skills and knowledge of healthcare to help improve the health of America's workforce? With a national...

  • Radiology Tech

    5 days ago


    Detroit, United States Ascension Full time

    Details Sign-on bonus: $7,500.00Department: Interventional RadiologySchedule: FT 40 hours per week, 5 days per week, 8 hour day shift with on call obligationsHospital: Ascension St. John HospitalLocation: Detroit, MISign-on bonus available based on eligibility.Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits...

  • Radiology Tech

    5 days ago


    Detroit, United States Ascension Full time

    Details Sign-on bonus: $7,500.00Department: Interventional RadiologySchedule: FT 40 hours per week, 5 days per week, 8 hour day shift with on call obligationsHospital: Ascension St. John HospitalLocation: Detroit, MISign-on bonus available based on eligibility.Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits...


  • Detroit, United States Ascension Full time

    Details Sign-on bonus: $7,500.00Department: Interventional RadiologySchedule: FT 40 hours per week, 5 days per week, 8 hour day shift with on call obligationsHospital: Ascension St. John HospitalLocation: Detroit, MISign-on bonus available based on eligibility.Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits...


  • Detroit, United States TeamHealth Full time

    Job Description Want to make great money, have your travel paid and enjoy your blocked time off? TeamHealth has an outstanding opportunity to join our elite special operations team! Our concierge travel support makes your travel coordination hassle-free, and our in-house licensing support specialist takes the headache out of obtaining licensure and...