Provider Credentialing Specialist
Ajilon Healthcare is seeking an experienced professional for the Provider Credentialing Specialist role. You will support the Credentialing Department by managing and maintaining accurate, up-to-date provider data. It is essential that candidates are capable of meeting a deadline to ensure production targets are met. Some basic functions of this role include primary source verifications, communicating with Providers to request missing information, supporting the integrity of Provider data in all downstream systems, and key-entering initial data of potential network Providers into the credentialing system. If you think this is a great fit to you, apply today!
· Process Provider credentialing inventory within expected timeline, accuracy and production targets.
· Update outdated provider credentialing and demographic information
· Reviews Provider applications and verify that each meets all credentialing criteria.
· Reviews Provider applications for accuracy and completeness and follows-up to obtain missing information materials in a timely manner and in accordance with department standards.
· Queries primary sources, as applicable, to verify Provider credentials and qualifications.
· Prepares files for review by the Credentialing Committee
· Maintains current credentialing, directory status information in a Provider credentialing system (Provider database.)
· Represents the Credentialing Unit at Credentialing Committee meetings as needed.
· Communicates, though both written and verbal communication, in a professional and concise manner and can share information and/or instructions for updating and correcting Provider credentialing databases.
· Coordinate with internal departments for Provider database related issues.
· Works with Credentialing Verification Organization(s) as directed.
Experience using Provider Credentialing software systems or Provider Data Management Systems
- Knowledge of URAC or NCQA standards
· High School Diploma or GED
· 1-year Provider Credentialing
Hours: 8AM-5PM (Monday- Friday)
Locations: North Phoenix
Employment: TTH, Full Time
If you are interested in this Provider Credentialing Specialist opening please apply online at Ajilon.com and email your resume Email blocked - click to apply.
1-year experience as a provider credentialist