Compliance & Credentialing Specialist

Responsibilities

• Captures and reviews provider files for completeness, accuracy, and compliance with federal, state, and facility regulations, guidelines, policies, and standards.
• Maintains oversight of provider files to ensure ongoing accuracy.
• Captures and reviews provider security and background check documents for completeness, accuracy, and compliance with federal, state, and facility regulations, guidelines, policies, and standards.
• Prepares, issues, electronically tracks, and follows-up on appropriate verifications with providers as part of the security process.
• Prepares and provides information to internal and external customers as needed.
• Enters, updates, and maintains data from provider files into the credentialing database in accordance with internal policies and procedures.
• Prepares, issues, electronically tracks, and follows-up on appropriate verifications with providers.
• Participates in the development and implementation of process improvements related to credentialing and compliance.
• Prepares and analyzes reports and data and communicates findings and results clearly.
• Communicates with providers and their liaisons to provide timely responses on day-to-day credentialing and privileging matters.
• Supports multiple team members and projects simultaneously while prioritizing tasks in a fast-paced environment.
• Performs miscellaneous job-related duties as assigned.

Qualifications

• Minimum of 5 years of credentialing experience.
• Bachelor’s or associate degree preferred.
• Prior government contracting experience strongly preferred.
• Eligible to work in the United States.
• Highly developed oral and written communication skills.
• Highly organized and strong time management skills.
• Extremely detail-oriented and capable of multitasking.
• Able to handle confidential information professionally.