Credentialing Specialist

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

📋 Description

• Maintain and manage credentialing information for both new and existing practitioners in health plans.

• Evaluate the adequacy and accuracy of participation details, including provider contract information.

• Input initial and ongoing credentialing applications into the Cactus credentialing information system.

• Confirm licenses, board certifications, and other necessary credentials through various sources.

• Analyze and report any adverse information from the National Practitioner Data Bank as well as state and federal sanctions.

• Retrieve any missing or expired information and documentation necessary for credentialing processes.

• Act as a resource for inquiries from physicians and providers regarding certification and credentialing.

• Identify complex or sensitive issues to escalate to the Credentialing Supervisor, or for potential review by a Medical Director or external source.

• Prepare credentialing files that meet compliance criteria for review by the Credentialing Compliance Coordinator/Supervisor and the Medical Director.

• Compile files that do not meet the criteria for review by the Medical Director, Senior Credentialing Specialist, or Supervisor, and for presentation to the Quality-of-Care Committee.

• Process practitioners in accordance with entity agreement terms, including files credentialed via a Certified Verification Organization.

• Participate in designated task forces and meetings.

• Execute additional assigned duties and projects as required.

⛳️ Requirements

• A high school diploma is required.

• 1-2 years of experience in the healthcare sector.

• Proficient with personal computers.

• Capability to recognize emergency situations and follow the appropriate protocols.

• Proficient in managing and utilizing a complex credentialing information system.

• Ability to prioritize various tasks and meet deadlines.

• Adaptability to changing environments.

• Excellent written and verbal communication skills.

• Initiative, sound judgment, outstanding organizational skills, and a meticulous attention to detail.

• Proficient in processing time-sensitive information.

• Ability to work under standard office conditions and remotely as needed.

• Capacity to use a telephone/headset and PC/keyboard simultaneously while sitting for extended periods.

• Willingness to work additional hours beyond the standard work schedule if necessary.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage.

• Retirement plan options.

• Paid time off benefits.

• Employer-sponsored life and disability insurance with additional buy-up options available.

• Tuition reimbursement program.

• Well-being benefits.

• A full suite of benefits to enhance career development, individual and family health, as well as financial health.

• Eligibility for variable pay.