Provider Credentialing Specialist

Job Description

Job Description

Onsite – Tower Building:
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 be designated 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. Knowledge of related state/federal regulations, NCQA, DIFS,MDHHS and CMS standards for credentialing
required.
4. Knowledge of CAQH required.

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. \nCompany Description

Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Kyyba is an Equal Opportunity Employer.

Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b

Company Description

Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.\r\n\r\nAt Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.\r\n\r\nKyyba is an Equal Opportunity Employer.\r\n\r\nKyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b