Credentialing Specialist

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Maintain and input provider demographic details obtained through contracts, roster updates, and/or applications into the CVO.

• Review data for accuracy and amend any identified errors.

• Ensure information remains up-to-date and complies with departmental standards.

• Extract and report data for analytical purposes.

• Assist in preserving database integrity and ensuring quality assurance.

• Reach out to providers to gather missing or inaccurate documentation and follow up as needed.

• Engage in discussions with network services personnel to troubleshoot and suggest program improvements.

• Aid in the Credentialing Committee's process for approval and denial notifications, including welcome and denial letters.

• Complete corporate tasks and additional responsibilities as assigned.

• Collaborate with various departments and the CVO to confirm that contracted providers meet the necessary qualifications.

• Support the reporting functions of provider data to agencies, committees, and management.

⛳️ Requirements

• High school diploma or equivalent is required.

• Post-secondary education is preferred.

• Prior experience in the healthcare sector is required.

• Experience in credentialing is necessary.

• Familiarity with CVO platforms is strongly preferred.

• Experience in data management within network services is preferred.

• Previous experience with Medicare Advantage plans is preferred.

• Experience in CMS reporting for providers and data reporting is preferred.

• Understanding of all provider types, affiliations, and relationships.

• Competent computer skills are required.

• Ability to accurately enter data into information systems.

• Capability to prioritize tasks and adapt to a dynamic work environment.

• Strong written and verbal communication skills are essential.

• Ability to manage multiple priorities, multitask, and meet deadlines.

• Capacity to work independently while following instructions.

• Travel may be necessary to attend the corporate office if located within 40 miles.

🏝️ Benefits

• Affordable Medical/Dental/Vision insurance options.

• Generous paid time-off program and paid holidays for full-time staff.

• TeleDoc provides 24/7/365 access to doctors.

• Optional short- and long-term disability plans available.

• Access to Employee Assistance Plan (EAP).

• 401K retirement accounts with company matching.

• Employee Referral Bonus Program.

• Option for remote work from home in a dedicated office space.

• Flexible hours may be available.