Senior Credentialing Specialist

The Senior Credentialing Specialist ensures providers are credentialed using vetted processes, maintains accurate data, and collaborates with stakeholders to ensure compliance with credentialing standards. They handle provider applications, communicate status, and support quality assurance activities.

Location: United States

Salary: USD $24.00–$28.00/Hr.

Responsibilities

• Handles and oversees the processing of provider applications and re-applications
• Maintains accurate provider profiling system data
• Communicates with providers concerning credentialing status
• Responds to requests for provider information
• Enforces regulatory compliance and quality assurance
• Support, in conjunction with the QA Team, any adverse action activities in accordance with regulations and policies
• Prepare documentation, conduct, and conclude credentialing and privileging
• Work, in conjunction with leadership, to identify potential 'pitfalls' in the CVO credentialing process
• Meet productivity standards as outlined in CVO and client metrics

Requirements

• Bachelor's Degree and/or equivalent work experience
• 3 plus years of experience in medical credentialing
• Strong knowledge of industry standards, to include but not limited to: TJC, NCQA, AAAHC and DNV
• Strong knowledge of the Microsoft office suite to include Excel
• Affinity to multi-task
• Certification Preferred: CPCS