| Location | Farmers Branch, TX |
| Job Type | Contractor |
Position Summary:
Responsible for ensuring providers meet all requirements and are approved to participate with client health plans. Maintains strong working relationships with Recruiting, Production, and Education departments.
Essential Functions:
Review credentialing and reappointment applications for completeness, accuracy, and compliance.
Conduct primary source verification and validate credentialing documentation.
Assess provider qualifications against credentialing standards and organizational requirements.
Investigate discrepancies, time gaps, and unusual information affecting credentialing eligibility.
Communicate identified concerns to credentialing leadership.
Monitor files for compliance with quality standards and accreditation requirements.
Maintain credentialing database records with a high degree of accuracy.
Track verification requests and follow-ups in accordance with established timelines.
Respond to provider and client inquiries related to credentialing activities.
Maintain knowledge of healthcare regulations and accreditation requirements.
Participate in professional development and special projects as assigned.
Qualifications:
Experience in a credentialing role required.
NAMSS Certified Provider Credentialing Specialist (CPCS) certification preferred or obtained within two years of eligibility.
CAQH experience preferred.
MD Staff experience preferred.
Google Workspace experience preferred.
Strong organizational and analytical skills.