DMC Primary Care , a physician-owned, independent practice, with offices throughout southern New Hampshire, has been providing comprehensive care for entire families since 1964.

We help each patient achieve the best possible health through every stage of life. We do this by providing an accessible, innovative healthcare experience that is built around our patient’s needs.

We are hiring a Provider Credentialing Specialist. This is a full-time position in Windham, NH. The Provider Credentialing Specialist is responsible for overseeing and coordinating DMC’s onboarding and credentialing process for new providers and ongoing revalidation.

The credentialing specialist will acquire primary source information necessary for DMC employment, as well as both initial and reappointment application or verification with all contracted health plans to ensure that all physician and non-physician provider requirements are met.

Maintaining accurate provider profiles on CAQH, PECOS, CMS, and other necessary databases Safeguarding the integrity of privileged information, credentialing and employment files in a professional and sensitive manner Identifying sanctioned providers on state and federal disciplinary action reports and initiates the requisite corrective processes to address cited violations Querying the National Practitioner Data Bank as needed, and does so in compliance with the Healthcare Quality Improvement Act (HCQIA) Remaining compliant with and knowledgeable of rules and regulations set forth by the Health Information Portability and Accountability Act (HIPAA), Joint Commission standards, the HCQIA, the National Committee for Quality Assurance (NCQA), the Centers for Medicare and Medicaid Services, as well as state regulations and relays this information to the necessary parties to ensure ongoing compliance organization-wide Providing all office visitors, credentialing contacts, payer representatives, and agency intermediaries with excellent customer service Collaborating with the billing department to help resolve and denials or authorizations issues related to provider credentialing Assisting the department manager and related staff with additional administrative tasks as needed Continuously seeking out further information and education through appropriate resources and references approved by management to research accurate answers and guidance for role and responsibilities.

This includes maintaining any necessary reference guides, policies, procedures, FAQs, etc as a resource and reaching out to management and or other appropriate individuals for guidance when research performed does not provide an appropriate resolution Possessing high-level organizational skills and the ability to multi-task and work under pressure, while presenting a calm, professional manner and positive attitude EDUCATION & TRAINING : High school diploma or equivalent required EXPERIENCE : At least two years of experience in healthcare provider credentialing required Proven experience working directly with healthcare personnel, such as physicians, in an office setting required Experience with Microsoft Office Suite (Word, Excel, Outlook, etc) LICENSE & CERTIFICATION : Training, education, or certification in practitioner credentialing preferred Full time positions offer : Competitive hourly salary Comprehensive medical / dental benefits at 32 hours Paid time off 401K For more information, please visit www.

DMCPrimaryCare.com . We are an equal opportunity employer embracing the strength that diversity brings to the workplace. We provide a welcoming and supportive environment for employees of all ethnic backgrounds, cultures, ages, lifestyles and physical abilities. Powered by JazzHR

Last updated : 2024-04-27