Credentialing Specialist

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

📋 Description

• Execute data entry, data collection, and verification of practitioner credentials from primary sources.

• Assess applications for completeness.

• Conduct, oversee, and analyze Primary Source Verifications (PSV).

• Investigate and confirm discrepancies and adverse information.

• Engage with healthcare practitioners to clarify inquiries and gather missing information.

• Follow up on application requests and pending PSVs.

• Maintain accurate and comprehensive records in the credentialing software database.

• Interact with internal and external customers to obtain or share information.

• Compile, assess, and present practitioner-specific data to the Credentials Committee.

• Generate and send approval, information-request, and termination notices based on the Credentials Committee's decisions.

• Request recredentialing applications from practitioners and organizational providers.

• Collaborate with contacts to efficiently process or terminate recredentialing applicants.

• Monitor provider expirables, including licenses, DEA, and malpractice insurance.

• Review federal/state sanctions and exclusions reports.

• Examine NPDB Continuous Query reports and take necessary actions.

• Support Delegation Oversight audit reviews, tracking, and reporting.

⛳️ Requirements

• High school diploma is mandatory.

• Associate degree is preferred.

• 1-4 years of experience in hospital or insurance plan credentialing.

• Proficient understanding of Joint Commission, NCQA, URAC, and HFAP standards.

• Certified Provider Credentialing Specialist (CPCS) certification is preferred.

• Candidates must be eligible to work in the US; visa sponsorship (H1B or otherwise) is not available.

🏝️ Benefits

• Commitment to Equal Employment Opportunity and a nondiscrimination policy.

• Currently, no visa sponsorship is available.