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Credentialing Specialist (Coordinator) (Health Care)

Job Description

Credentialing Specialist (Coordinator) – Health Care Office

  1. Ensuring the quality of credentialing files of contracted providers in accordance with NCQA and DHS guidelines.
  2. Responsible for maintaining internal quality standards, supporting the Credentialing Committee program and coordinating Health plan activities.

About the Job:

      • Processes credentialing/re-credentialing files for committee review (NCQA/state regulatory requirements)
      • Ensures that provider files are presented to committee
      • Responds to inquiries from IPA Services on credentialing status
      • Ensures the timely notification of provider changes
      • Monthly maintenance of files to ensure compliance
      • Tracks and monitors non-responsive providers
      • Maintains confidentiality and security of files
      • Ensures files ready for committee review
      • Assists in auditing credentialing files for committee presentation
      • Ensures all outstanding issues are resolved prior to committee review
      • Prepares list of provider credentialing to Medical Director for Credentialing Committee review and approval
      • Coordinates and prepares the credentialing committee meetings
      • Assists the Credentialing manager with special projects as needed

Job Requirements

  1. One year experience in Health Care credentialing or equivalent.
  2. Strong communication, interpersonal and customer service skills.
  3. Excellent organizational skills with an attention to detail
  4. Knowledge of NCQA/state/federal standards. 

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Insurance
Education Not Specified
Experience At least 1 year(s)
Manages Others No
Relocation No
Industry Managed Care, Healthcare - Health Services, Insurance
Required Travel None
Job ID 08A*
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Credentialing Specialist (Coordinator) (Health Care)

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