This is a temporary position that will last for 3 to 6 months.
Hours are 8:00 a.m. - 5 p.m., Monday through Friday.
The Credentialing Specialist collects and verifies sensitive provider data through confidential sources and maintains credentialing database.
Essential Duties and Responsibilities:
- Maintains the credentialing database and tracks all direct provider contract data.
- Coordinates credentialing and recredentialing activities of each provider according to program policy.
- Enters all credentialing information into credentialing module and submits for credentialing.
- Prepares files for presentation to the Chief Medical Officer and Credentialing Committee.
- Coordinates and communicates activities with the Credentialing Committee.
- Prepares and distributes minutes to Credentialing Committee members and other internal staff.
- Activates and deactivates direct contracted providers in the provider database.
- Performs primary and secondary source verifications of credentials according to departmental policy.
- Assists in auditing delegated credentialing functions in accordance with policies and procedures.
- Notifies Network Services Representatives when unable to obtain required documentation.
- Audits files for completed information upon submission, requests missing data from providers.
Supervisory Responsibilities: None
- Adheres to the policies and procedures of Premier Administrative Solutions
- Maintains strict confidentiality of client, company and personnel information
- Demonstrates a strong commitment to the mission and values of the organization
- Adheres to company attendance standards
- Performs other duties as assigned
- Strong organizational and interpersonal skills
- Excellent written and verbal communication skills
- Detail oriented
- Ability to multi-task and work independently
Education and/or Experience:
- A Minimum of 2 years’ experience working in a managed care, hospital or medical office environment is required.
- Three years of credentialing experience is preferred with a working knowledge of NCQA and URAC credentialing preferred.
An Associate’s Degree or equivalent education and work experience is required. Equivalent experience includes two years managed care, hospital or medical office environment.
Certificates, Licenses, Registrations: None
Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook. Experience with credentialing software is desirable.
Environmental Factors/Physical Demands:
Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds .
To apply, please forward resume to firstname.lastname@example.org
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