Credentialing Specialist

Elevait Solutions; Philadelphia (Philadelphia County); On-site; USD 45,000 - 65,000; Full time

Job summary

A healthcare solutions company is seeking a Credentialing Specialist in Philadelphia. The role involves processing provider applications, conducting verifications, and ensuring compliance with NCQA and legal standards. Candidates should possess strong verbal and written communication skills, along with the ability to work in a metrics-driven environment. Proficiency in Microsoft Office is also required. This position offers a full-time commitment for over 5 months, providing an opportunity to delve into the credentialing field.

Qualifications

• Intermediate knowledge of PC applications including Microsoft Office.
• Strong verbal and written communication skills.
• Strong organizational skills.
• Ability to perform in a metrics-driven environment.

Responsibilities

• Validates completeness of provider applications before processing.
• Conducts primary source verification for all credentialing applications.
• Monitors the completion of all site visits by the provider network team.
• Accurately enters critical data elements into the Credentialing system.
• Responds to phone inquiries from internal and external clients.
• Completes assigned projects.

Skills

Intermediate knowledge of PC applications

Strong verbal communication skills

Strong written communication skills

Strong organizational skills

Ability to perform in a metrics-driven environment

Tools

Microsoft Office

Job description

Credentialing Specialist

Location: Philadelphia PA

Duration: 5+ months

Shift: 1st shift. 40 hours a week

The Credentialing Specialist is responsible for processing and completing the credentialing and re-credentialing functions of all providers by NCQA, state, and federal requirements.

Responsibilities

• Validates completeness of provider applications before processing.
• Conducts primary source verification for all credentialing and re-credentialing applications.
• Monitors the progress and completion of all site visits by the provider network team to ensure completion within the established time frame.
• Accurately enters all critical data elements of provider applications into the Credentialing system.
• Responds to phone inquiries received in the Credentialing phone queue from internal and external clients.
• Completes projects as assigned.

Requirements

• Intermediate knowledge of PC applications, including Microsoft Office.
• Strong verbal and written communication skills.
• Strong organizational skills.
• Ability to perform in a metrics-driven environment.

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