Credentialing Specialist

Scope of Position:

The Credentialing Specialist will assume total responsibility of credentialing of providers from hire to enrollment in managed care plans. The Credentialing Specialist provides services for all entities within the healthcare system.

Position Summary:

Primary responsibility will be initiating and monitoring the provider corporate credentialing functions to assure that all practitioners are credentialed in accordance with established thresholds. This would include primary source verification and medical staff privileging assuring compliance with NCQA and JCAHO standards. Also, responsibility will include enrollment into governmental payor plans (Medicare, Medicaid, Bureau of Workers Compensation, etc.) and enrollment into other non-delegated health plans. CVO Specialist may also be asked to work on special projects for providers, which might include assisting with credentialing process for other healthcare institutions when a business relationship exists. This position requires excellent verbal and written communication skills and the ability to work independently, while managing multiple priorities.

Required Qualifications:

• Bachelor's degree in health related or educational field

• 4 years experience in a hospital setting and/or managed care setting or equivalent combination of education and experience

• Strong verbal and written communication skills; Strong organizational skills and attention to detail

• Ability to work with minimal supervision and to maintain confidentiality due to access to sensitive information

• Ability to problem solve and think creatively

• Knowledge of NCQA and JCAHO as they relate to current credentialing and re-credentialing standards

• Working knowledge of Microsoft Word and Excel

• CPMSM or CPCS certification preferred

Our Comprehensive Employee Benefits Include:

• An array of retirement plan options, each with a generous employer contribution.

• Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.

• Paid vacation and sick leave, including short and long-term disability and paid parental leave.

• Get the most out of the Public Service Loan Forgiveness program.

• And much more!