Sr. Credentialing Specialist
$38,480–$73,403 year
HybridDallas, Texas, United States
Job Summary
Serve as a subject matter expert on credentialing for internal staff and external customers, ensuring all functions comply with URAC guidelines, NCQA standards, and applicable state and federal requirements. Prepare and provide education and training to Credentialing Specialists on policies and processes, while organizing audits to evaluate compliance and deliverable timelines. Review and process new clinician credentialing files, perform primary source verifications via state boards and NPDB, and assemble verified information for the Credentialing Committee. Maintain accurate copies of licenses, DEA certificates, and malpractice coverage, and review background checks, drug tests, and TB screenings. Utilize the MD Staff credentialing database to generate reports and optimize efficiency, while maintaining security and privacy of protected health information.
Required Qualifications
- 3+ years of successful work experience, preferably in a credentialing role/department
- Must be familiar with NCQA accreditation standards
- Working knowledge of problem-solving and decision-making skills
- Demonstrates active listening skills and strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders
- Strong organizational skills- attention to detail
- High school diploma or equivalent required
- Must be available for Hybrid every other Tuesday in office
- Must be able to work remotely
Desired Qualifications
- NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS), or ability to obtain within 2 years of eligibility
- Demonstrated ability to organize and prioritize workload and day-to-day tasks
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