Credentialing Specialist

Responsibilities

Position ensures thorough and accurate investigation of background and credentials for all practitioners and facilities contracted to provide care to Health Plan members. Position evaluates adequacy of information presented by all applicants for initial and re-credentialing, directing and overseeing primary source verification of all credentialing elements, and ensuring clarification of any discrepancies discovered in the verification process. Position accurately summarizes and reports the results of each investigation to the Medical Director and Plan Credentialing Committee, with written follow-up regarding credentialing determinations, as required. Position is also responsible for ensuring processes demonstrate compliance with State, Federal and National regulatory requirements and the accreditation standards of the National Committee for Quality Assurance (NCQA) and Medicare (CMS).

Benefits

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries

More information is available on our Benefits Guest Website: benefits.uhsguest.com

Qualifications

• High school diploma or equivalent
• 1 – 3 years related experience
• Requires strong skills for communication in English, both verbally and in writing with provider applicants, applicants’ staff, the Medical Director, the Credentialing Committee, and other departments within the organization
• Must be highly detail oriented and requires strong organizational and prioritization skills, as well as the ability to complete job responsibilities of a confidential nature, with significant accountability and accuracy to meet established timelines
• One year physician office or related medical care experience required
• Medical staff office experience preferred
• Credentialing experience strongly preferred
• Excellent computer skills including word-processing, databases, spreadsheets and graphics
• Well-developed professional interpersonal written and oral communication skills
• Strong medical terminology recommended
• Strong organizational skills with the ability to prioritize multiple tasks/projects using established protocols and guidelines to determine the appropriate course of action and meet established timelines
• Strong customer service skills that contribute to a customer-oriented team and department
• Motivated, flexible, and a self-starter
• Requires assertiveness, creativity and good problem-solving skills

About the Company

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Learn more at prominence-health.com.

Universal Health Services, Inc. (UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. UHS has been recognized as one of the World’s Most Admired Companies by Fortune and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located across the U.S., Washington, D.C., Puerto Rico and the United Kingdom. Learn more at uhs.com.