Delegated Credentialing Specialist, Temp

Overview Credentialing Specialist is responsible for credentialing and recredentialing client practitioners, and ensuring enrollment with participating client health plans. Responsibilities Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for payor enrollment and credential verification process. Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s). Enroll providers with client payors to include Medicare, Medicaid and state and federal commercial health plans and follow up as required until process complete. Update CAQH and NPI information consistent with client practice information. Gather, verify, evaluate highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standards. Respond to all practitioner, client health plan and internal inquiries in a timely manner. Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed timeframe. Maintain practitioner paper and electronic data files for clients; utilizing CAQH to submit practitioner data as required to credential individual practitioners. Collaborate with participating clients in a professional manner, department manager and/or external agencies to facilitate and ensure smooth hand‑off during the credentialing process. Follow up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process. Perform all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner files. Conduct sanctions and compliance monitoring and alert Manager of any undisclosed negative findings immediately. Participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency. Contribute to positive culture. Keep Manager informed of potential credentialing or enrollment issues. Qualifications Proficient using payor websites including but not limited to CAQH, Pecos, NPI/NPPES, Availity, NaviNet, CMS I&A. Proficient with various software used for provider applications, verifying credentials and tracking verification statuses. Proficient with payor enrollment process for all levels of licensure including but not limited to MD/DO, NP, PhD, PT, OT, LCSW, OD, DDS, DPM, etc. across all specialties including medical, dental, vision, behavioral health and physical health. Knowledge of primary source verification--understand the process of verifying information directly from the original/authorized source that meets relevant regulations, accreditation requirements and compliance standards. Experience: 3-5 years of responsibility for medical credentialing processes, policies and procedures and delegated credentialing requirements. Ability to communicate clearly and concisely, both verbally and in written correspondence. Ability to work well under tight deadlines and respond to rapidly changing demands and provide efficient follow up. Detail oriented with ability to recognize vital information from credentialing documents. Demonstrate problem‑solving, critical thinking, and deductive reasoning skills. Ability to consistently maintain quality and production expectations. Ability to learn and use credentialing database and other related databases. Comfortable dealing with sensitive and confidential information with discretion and trust. Proficiency with MS Office suite. Associate’s degree or an equivalent combination of education and/or experience. Minimum of 3 years’ experience in provider credentialing in a healthcare setting. Certified Provider Credentialing Specialist (CPCS) preferred. Provider Enrollment Specialist Certificate (PESC) preferred. Compensation & Benefits Pay: $25.00/hour Competitive pay Flexible work schedules, including work from home options available Award‑winning training and development programs EEO Statement We welcome applicants of any race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, and individuals with disabilities as an affirmative action/equal opportunity employer. We are an at‑will employer. #J-18808-Ljbffr CHG Management, Inc.