Healthcare Credentialing Specialist OpTech

LLC - 4.2

Detroit, MI Job Details Temp-to-hire | Contract $20 - $23 an hour 17 hours ago Benefits Health insurance Dental insurance Paid time off Vision insurance Life insurance Qualifications Microsoft Excel Interpersonal skills Caseload management Medical office experience Provider enrollment for medical credentialing CMS State healthcare regulations CMS regulatory compliance Attention to detail Organizational skills Productivity software Full Job Description

LONGTERM CONTRACT WITH POTENTIAL TO BE HIRED DIRECTLY BY THE CLIENT.

If you feel you are a perfect match for this position, please connect with me directly on LinkedIn, and message me! 2 days a week in office/Detroit. Long term growth potential, great foot in the door. Tom Cassidy/OPTECH This role is responsible for managing the credentialing and recredentialing process for healthcare providers and organizations to ensure compliance with state, federal, and NCQA accreditation standards . The position includes reviewing applications, verifying credentials through primary sources, maintaining accurate records, and communicating status updates to internal teams and providers. The role also supports audits, resolves inquiries, and may participate in committee meetings and special projects. It is a hybrid position requiring 2 days onsite per week , with the candidate residing in the local metropolitan area.

Top Required, Must-Have Skills:

1. Credentialing processing experience (provider/practitioner/facility) 2. Knowledge of state & federal regulations (NCQA, CMS, DIFS, MDHHS) 3. Experience with CAQH 4. Strong organizational skills & attention to detail 5. Ability to manage multiple cases and deadlines simultaneously 6. Strong verbal and written communication skills 7. Ability to work independently and in a team environment 8. Proficiency in Microsoft Office (Word, Excel, Access, PowerPoint) Preferred Skills 1. Experience in provider enrollment, medical practice, hospital business office, or contracting 2. Experience participating in credentialing committees or audit processes 3. Exposure to process improvement, job aids, or special projects

Years of Experience Required Required:

2 to 5 years of relevant experience in: Provider enrollment Credentialing Medical practice or hospital business office Healthcare contracting or related field

Education Requirements Preferred:

Associate degree (Relevant professional experience can support qualifications even if degree is not strictly required) Client notes are below: Onsite - Tower Building 600 Lafayette Detroit MI The resource will be required to work onsite two days per week and may work remotely for the remaining three days. Resource must live in the metropolitan area. Summary Process practitioner and organizational provider applications for credentialing based on State and Federal regulations and NCQA accreditation standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES

include the following. Other duties may be assigned. 1. Responsible for the processing of practitioner and organization/facility provider applications for credentialing and recredentialing; requesting primary source documentation, processing documentation requirements, verifying information received, updating information in the system of record, evaluating over all case categorization and reporting findings to the Medical Director and Enterprise Credentialing Committee. 2. Resolve inquiries related to credentialing file disposition. 3. Provide credentialing status information for group administrators, physicians and their staff, Provider Services, Customer Service and Network Development Inquiries. 4. May bedesignated by the leader to attend Credentials Committee meetings and conduct internal meetings and participate in auditing processes. 5. Assist with special projects and job aids as needed.

EDUCATION AND EXPERIENCE 1.

Associate degree preferred. 2. Two (2) to five (5) years of work experience in provider enrollment, contracting, medical practice or hospital business office role and/or credentialing related field required. 3. Knowledgeof related state/federal regulations, NCQA, DIFS,MDHHS and CMS standards for credentialing required. 4. Knowledgeof CAQH required.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

OTHER SKILLS AND ABILITIES 1.

Excellent organizational skills with attention to detail required. 2. Excellent verbal and written communication skills required. 3. Ability to handle and prioritize multiple case files and timelines required. 4. Ability to work effectively independently or in a team environment required. 5. Intermediate knowledge of Microsoft Word, Excel, Access, PowerPoint, and internet use required.

Pay:

$20.00 - $23.00 per hour Expected hours: 40.0 per week

Benefits:

Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

Hybrid remote in Detroit, MI 48226