Credentialing Specialist
RemoteUnited States
Job Summary
Audit Provider Licensure Files against NCQA guidelines and pull monthly Delegated Verification Files. Prepare and present provider files for internal and external auditing while uploading and updating systems with new documents. Request licensure renewals, utilize licensure portals, and process manual verifications for education, hospital privileges, and board certifications. Coordinate, monitor, and maintain all internal re-credentialing activities. Assist offices and internal departments with credentialing issues, ensuring compliance with legal and regulatory policies. Utilize licensure portals and speak effectively with providers, educators, and internal departments.
Required Qualifications
- High School Diploma
- 2-3 years' experience in Healthcare Credentialing
- Dental experience
- Excellent verbal and written communication skills
- Well organized and detail-oriented with the ability to multi-task
- Proficiency with Microsoft Office products, including Word, Excel, Outlook, and Adobe
- Ability to function with minimal supervision
- Ability to prioritize all work tasks
- Designated workspace with high-speed internet and access to hot spot if needed
Desired Qualifications
- Experience in Manual Education Verifications
- Experience in Manual Hospital Privileges Verifications
- Experience in Board Certification Verifications through the appropriate portals
- Strong understanding of the differences between similar credentials (ie. Malpractice, Diplomas, etc.)
- Knowledge of what a Credentialing Committee consists of
- Ability to speak effectively with providers, educators and internal departments
- Ability to multi-task in a fast-paced environment
- Work other projects as assigned
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