Credentialing Specialist

The credentialing specialist plays a critical role in the organization by ensuring that our healthcare facilities and physicians are following federal and state guidelines and that medical providers have the necessary licenses they require. The Credentialing Specialist also maintains records of training and certifications for medical staff. Credentialing specialists utilize their acute knowledge of medical terminology, their solid research skills, and their exceptional organizational skills to verify the credentials of our providers and make sure they are able to practice responsibly and provide Premium Health’s utmost standard of CARE: Compassion, Agility, Respect, and Excellence.

Time Commitment:

• Monday-Thursday: 9:00 AM - 5:00 PM
• Friday: 9:00 AM - 2:00 PM

Compensation:

• $23-$25 per hour, commensurate with experience

Responsibilities:

Credential Verification

• Review and authenticate credentials, qualifications, licenses, certifications, and other relevant documents submitted by individuals or organizations to ensure that the provided information is accurate and meets the required standards.
• Conduct credentialing and contracting for the organization, and the providers within the organization with Health Insurance payors so provided services can be billed. This involves maintaining the provider's credentialing file, maintaining CAQH profiles (online database applications with the provider's complete profile), submitting the applications, and following through until applications are approved.

Compliance Assessment

• Ensure individuals or organizations comply with all legal and regulatory requirements. This may involve checking if licenses are valid, certifications are up-to-date, and professionals meet the necessary educational or training standards.

Database Management

• Help develop internal credentialing processes.
• Maintain comprehensive databases or records of credentialed individuals or organizations.
• This includes updating information, tracking expiration dates of licenses or certifications, and ensuring accuracy and confidentiality of data — all an ongoing part of compliance.

Communication and Collaboration

• Advise staff members of required “renew by” dates
• Work closely with providers and organizations to provide guidance on compliance.
• Respond to inquiries, stay up-to-date on credentialing requirements, and facilitate communication to resolve compliance issues.

Qualifications:

• High School diploma or equivalent preferred
• Associate degree in healthcare or business administration preferred
• Ability to meet strict deadlines
• Attention to detail
• Good communication skills
• Knowledgeable in policies, laws and procedures
• Strong computer skills
• Proficiency in database management
• Willingness to work as a team player
• Excellent multi-tasking, telephone and organizational