Job Description

Position Summary

The Credentialing Specialist will assist in all Payer and Hospital Credentialing efforts. The key role of the Credentialing Specialist is to ensure that all new providers are successfully and seamlessly enrolled for privileges at all required facilities, and effectively enrolled with all contracted payers, along with performing all recredentialing responsibilities associated with these processes.

Primary Functions & Accountabilities

Facilitate application and document collection for all new OV providers, including assisting providers new to the State with DEA and licensure applications.

Submit and follow all facility credentialing and recredentialing processes.

Submit provider applications and updates to Payers

Perform Primary Source Verifications

Maintain Provider data and current documentation in the Credentialing and Enrollment database

Ensure that all Providers are recredentialed within required timeframes.

Knowledge, Skills & Abilities

Bachelor's degree preferred

Knowledge of Provider Enrollment processes

3 years work experience in practice or health plan credentialing required

Knowledge of Primary Source Verification processes

Knowledge of NCQA, URAC and TJC credentialing standards

Knowledge of Facility Accreditation standards

Experience with CAQH

Job Tags

Work experience placement,

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