Job Description

CREDENTIALING SPECIALIST

Coordinate all credentialing activities to ensure provider participation with CenterLight Healthcare. Ensure provider compliance with credentialing standards. Conduct outreach to providers for verification and request for information. Location: Wallerstein Setting: : Hybrid (Wed & Friday in Office) Schedule: Monday - Friday 8:30 am-5:30 pm (1 hour lunch)

JOB RESPONSIBILITIES INCLUDE:

• Coordinate provider credentialing process to increase efficiency and ensure that credentialing deadlines are met.
• Research and solve credentialing/re-credentialing delays & issues with enrollment in a timely manner.
• Manage confidential information of internal staff (Physicians, Nurse Practitioners).
• Ensure demographic updates are reviewed and verified for processing.
• Ensure the database is kept accurate and updated.
• Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re-credentialing to ensure requirements are met in a timely manner.
• Prepare documents for Credentialing Committee review.
• Outreach to provider for information verification and miscellaneous inquiries, i.e. provider portal access, nursing home documentation, medical records retrieval, etc.
• Provide productivity and issues reports for Management.
• Remain current on policies affecting provider credentials and enrollment processes.

QUALIFICATIONS INCLUDE :

Associates/Bachelor's Degree, and/or equivalent work experience. Experience:

• A minimum of three (3+) years of credentialing experience.
• Preferred: Credentialing in a Healthplan setting.
• Microsoft Office/Suite Proficient (Excel, Outlook, Word, etc.) Phaxis

Job Tags

Work experience placement, Monday to Friday,

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