Credentialing Specialist

The Credentialing Specialist is responsible for maintaining active status for all providers in the network by successfully completing initial and subsequent credentialing as required by NCQA. This individual will work closely with all plans to ensure proper credentialing is completed and sent to partnering plans in a timely manner including: Closely monitoring state and federal databanks to ensure providers licensure compliance; report any misdemeanors to plans automatically; work closely with delegated partners for chart audits and regulatory affairs; ensure updated information is reported to credentialing software. Additionally, this role is responsible for the contracting of physicians in all plans within the network.

Duties/Responsibilities:

Initial Credentialing; track paperwork and fees Re-credential ALL providers every three (3) years Closely monitor paperwork submitted to participating plans for all providers in network Collect updated licensure, malpractice and CME information from all providers each year Monitor state and federal databanks Ensure tidiness of each Physician file to comply with NCQA Compliance with health plans annual credentialing audits Organize Credentialing quarterly committee meetings to review all initial and recredentialed providers Submit provider changes to plans as necessary Submit and monitor physician contracts to health plans

Required Skills/Abilities:

Ability to work independently and organize time effectively Ability to work under time restraints

Education and Experience:

Bachelor's degree in Healthcare related field or experience in credentialing role preferred

Job Type:

Full-time Pay:

$45,000.00 - $60,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person