Job Description

Job Description

Job Description

Description

Job Title: Credentialing Specialist 
Department: Operations - Credentialing 

We are currently seeking a highly motivated Credentialing Specialist. This role will report to the Supervisor - Credentialing and enable us to continue to scale in the healthcare industry. The Credentialing Specialist fulfills all activities required for successful completion of initial and re-credentialing applications. Key responsibilities include Credentialing Committee preparation and scheduling, responding to health plan credentialing audits, and successful integration of credentialing files for newly acquired entities. This is a hybrid/remote role where the expectation is to work both in office and at home on a weekly basis (dependent on the employee’s location). 
What You'll Do

• Process initial and reappointment credentialing applications and conduct follow up as needed 
• Quality spot check applications before submission to committee
• Prepare monthly reports for peer review/credentialing committee meetings 
• Input all credentialing data into credentialing software database accurately and timely 
• Work closely with IPAs and Hospitals to ensure exceptional customer service 
• Maintain provider state licenses, DEA certificates, malpractice insurance and any other required credentialing documents 
• Represents the MSO while interacting with internal and external contacts 
• Remain up to date with credentialing accreditation standards with NCQA and Joint Commission 
• Knowledge of current credentialing standards published by Joint Commission and/or NCQA 
• Ability to analyze complex application problems and provide solutions • Ability to work with multiple projects and deadlines 
• Excellent written and verbal communication skills 
• Detail oriented and possess strong organizational skills in a fast-pace environment 

Qualifications:

• High School Diploma 
• Bachelor’s Degree 
• Licensure, Certification, Registration: CPCS or CPMSM certification 
• 2-3 years’ credentialing experience within a managed care, hospital or CVO credentialing 

Environmental Job Requirements and Working Conditions

• This position is in office with the option to be hybrid or remote (dependent on the employee’s location. 
• The office is located at 19500 Hwy 249 Suite 570 Houston, TX 77070. 
• The total compensation target pay range for this role is: $22.00 to $28.00 per hour. The salary range represents our national target range for this role 

Job Tags

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