Credentialing Specialist

Understanding of corporate structures and the ability to accurately interpret contracts, credentialing attestations, and related documentation. Responsible for reviewing, processing, and maintaining provider credentialing information with accuracy, confidentiality, and attention to detail.

Provider Credentialing Specialist


Job Summary

Responsible for reviewing, processing, and maintaining provider credentialing information with accuracy, confidentiality, and attention to detail.

Responsibilities

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  Review provider credentialing and re-credentialing packets for missing information.
  
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  Request missing information from providers and resolve discrepancies between submitted information and findings from external sources.
  
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  Create and update provider information in the credentialing system to ensure timely and accurate completion.
  
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  Respond to provider inquiries by phone and correspondence.
  
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  Research and verify provider participation status and applicable credentials.
  
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  Contact providers regarding missing or expired information.
  
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  Process incoming and outgoing mail.
  
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  Perform other related duties as assigned.
  

Requirements

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  High school diploma or GED preferred;relevant experience may be considered in place of education.
  
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  At least two years of related experience.
  
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  Ability to maintain the confidentiality of provider information.
  
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  Understanding of corporate structures and the ability to accurately interpret contracts, credentialing attestations, and related documentation.
  
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  Strong mathematical skills for compiling and validating statistical calculations and reconciling discrepancies.
  
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  Knowledge of English grammar, composition, editing, and proofreading.
  
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  Ability to understand complex written and verbal instructions.
  
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  Strong written and verbal communication skills.
  
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  Ability to work effectively with coworkers and external contacts.
  
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  Proficiency with standard office equipment and Microsoft Office applications, including Word, Excel, Access, and database systems.
  
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  Ability to enter information accurately into credentialing systems and related data repositories.
  
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  Ability to remain seated for extended periods and use a computer and other office equipment.
  
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  Ability to occasionally stand, walk, stoop, kneel, climb, and lift up to 25 pounds.
  

Skill

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  Credentialing and provider data management
  
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  Data entry and document verification
  
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  Attention to detail and accuracy
  
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  Analytical and problem-solving skills
  
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  Organization, time management, and multitasking
  
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  Written and verbal communication
  
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  Microsoft Office and database proficiency
  

Summary Qualification

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  Two or more years of relevant experience in credentialing, healthcare administration, data management, or a related field.
  
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  Strong ability to review, verify, and maintain confidential provider information.
  
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  Highly organized and detail-oriented with effective analytical and communication skills.
  
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  Comfortable working with complex documentation, computer systems, and database applications.
  

 

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.