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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Responsible for obtaining and maintaining critical provider credentialing data necessary for initial and recredentialing reviews to determine participatory status, ensuring selection of providers who possess and maintain the clinical skills necessary to deliver high quality of healthcare and service excellence to PacificSource members.
Follow credentialing procedures, accreditation and regulatory requirements to ensure timely, accurate credentialing of practitioners affiliated with PacificSource.
Maintain current credentialing information and frequent communication with practitioners regarding credentialing issues and practice information.
Essential Responsibilities :
Perform projects including generation and review of reports and data entry corrections to improve system integrity and compliance.
Supporting Responsibilities :
Work Experience : Minimum of two years health insurance experience or equivalent required, credentialing experience preferred.
Education, Certificates, Licenses : High School Diploma or equivalent required, Associate Degree preferred. NAMSS Certified Provider Credentialing Specialist Certification (CPCS) preferred.
Knowledge : Effective written and verbal communication skills. Must be highly organized and possess strong interpersonal skills.
Knowledge of NCQA credentialing standards as well as state and regulatory credentialing requirements. Knowledge of policy and procedure development.
Computer skills, including word processing, spreadsheets, and database applications is required. Ability to tactfully interact with medical practitioners, staffs and handle a variety of situations is required.
Excellent organizational and communications skills required.
Competencies : Adaptability
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Environment : Work inside in a general office setting with ergonomically configured equipment. Some travel may be required 5% of time for training, external meetings and credentialing audits.
Work hours may include early mornings, evenings, and out of town travel, occasionally overnight.
Skills :
Accountability, Collaboration, Communication (written / verbal), Flexibility, Group Problem Solving, Listening (active), Organizational skills / Planning and Organization, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :
Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.
Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change.
It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.
Employment remains AT-WILL at all times.
Last updated : 2024-05-09
Full Time
$44k-55k (estimate)
05/09/2024
05/15/2024
The job skills required for Credentialing specialist include Customer Service, Commitment, Confidentiality, Written Communication, Data Entry, Problem Solving, etc. Having related job skills and expertise will give you an advantage when applying to be a Credentialing specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Credentialing specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Credentialing specialist positions, which can be used as a reference in future career path planning. As a Credentialing specialist, it can be promoted into senior positions as a Compliance Manager - Healthcare that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Credentialing specialist. You can explore the career advancement for a Credentialing specialist below and select your interested title to get hiring information.
If you are interested in becoming a Credentialing Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Credentialing Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Credentialing Specialist job description and responsibilities
A certified professional credentialing specialist ensures that staff members of a facility maintain licenses, training, and certifications based on federal and state law.
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Credentialing specialists also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies.
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Credentialing specialists are part of an organization's administrative staff; they review medical policies, process contracts, and facilitate audit reports to validate that certified medical professionals comply with credentialing procedures.
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Credentialing specialists will also ensure that their employer meets state, federal and other regulations for quality of care.
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Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Credentialing Specialist jobs
Credentialing specialists can often find work with a high school diploma or the equivalent.
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Some employers strongly prefer credentialing specialists who have a Certified Provider Credentialing Specialist (CPCS) credential.
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While an associate degree may not be required for a position as a credentialing specialist, some employers may prefer applicants with a two-year degree.
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Make Use Of Advanced Software For Monitoring.
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Stay Updated with the Coalition for Affordable Quality Healthcare's Credentialing Program.
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Step 3: View the best colleges and universities for Credentialing Specialist.