Delegated Credentialing Specialist, Temp

Credentialing Specialist

The Credentialing Specialist is responsible for credentialing and recredentialing client practitioners as well as ensuring enrollment with participating client health plans. This is a temporary position, expected to last no more than one year.

• 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 credentials 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
• Responsible for gathering, verifying evaluating 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
• 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
• Contributes 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
• Proficiency ins using 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
• Experience should include 3-5 years of responsibility for medical credentialing processes, policies and procedures and delegated credentialing requirements
• Able to communicate clearly and concisely, both verbally and in written correspondence
• Able 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
• Able to consistently maintain quality and production expectations
• Learn and use credentialing database and other related databases
• Capable and comfortable dealing with sensitive and confidential information with discretion and trust
• Proficiency with MS Office suite

Education & Experience

• 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

Pay

We offer a pay of $25.00/hour.

Schedule

In Return, We Offer Competitive pay Flexible work schedules - including work from home options available Award-winning training and development programs Click here to learn more about our company and culture.

About the Role

CHG Healthcare values a diverse and inclusive workforce. Interested in this role but not a perfect fit? Apply anyway. 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.