Credentialing specialist

This position is (40 hours/week) Monday-Friday and will be located at 4101 Percival Road, Columbia, S.C., 29219.

What You Will Do:

• Performs initial and re-credentialing of providers/practitioners including documenting credentialing information according to established policies/procedures.

• Completes primary verification of the following: state licensure, state/federal controlled substance certification, educational and/or residency background, malpractice coverage/history, hospital privileges, and previous sanctions.

• Maintains credentialing database and HCS data files with appropriate network indicators and effective dates.

• Ensures provider databases are kept current and accurate.

• Retrieves and interprets credentialing database information for use in various reports.

• Communicates (both verbally and in written form) with providers, provider relations, marketing, other credentialing departments, and various management staff relating to any urgent matters.

• Registers all participating providers and assists provider network personnel in maintaining and/or updating directory information.

• Responds to calls/correspondence from physician/provider/office staff regarding participating networks, directories, and provider credentialing.

• Ensures communication of provider profiling and performance information with other provider services areas.

• Prepares correspondence and credentialing reports as requested by management.

• Assembles necessary information on providers due initial credentialing or re-credentialing for presentation to credentialing committee.

• Attends meetings of credentialing committee as scheduled.

• Assists in research, redevelopment, and implementation of any new programs/projects. Provides administrative support to delegated credentialing activities.

To Qualify for This Position, You Will Need:

• Associate degree OR two years of related work experience.

• Two years' experience in the healthcare OR insurance industry.

• Good judgment skills.

• Effective organizational and customer service skills.

• Demonstrated verbal and written communications skills.

• Demonstrated proficiency in spelling, punctuation, and grammar skills.

• Ability to handle confidential OR sensitive information with discretion.

• Knowledge OR the ability to acquire of organization/committee standards, delegation agreements, etc.

• Microsoft Office.

We Prefer That You Have The Following:

• Prior credentialing experience

What We Can Do for You:

• 401(k) retirement savings plan with company match

• Subsidized health plans and free vision coverage

• Life insurance

• Paid annual leave - the longer you work here, the more you earn

• Nine paid holidays

• On-site cafeterias and fitness centers in major locations

• Wellness programs and healthy lifestyle premium discount

• Tuition assistance

• Service recognition

• Incentive Plan

• Merit Plan

• Continuing education funds for additional certifications and certification renewal

What to Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.