Credentialing Specialist

Prominence Health; Reno (NV); On-site; USD 50,000 - 75,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive compensation & generous PT

Excellent Medical, Dental, Vision and

401(K) with company match

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health is seeking a Credentialing Specialist responsible for thorough investigations of background and credentials for all practitioners and facilities contracted to provide care to Health Plan members. You will oversee primary source verification and ensure discrepancies are clarified, with reporting to the Medical Director and Plan Credentialing Committee.

This role ensures compliance with State, Federal and NCQA/CMS accreditation standards, delivering accurate credentialing

Qualifications

• High school diploma or equivalent.
• 1–3 years related experience; credentialing experience preferred.
• Strong English communication, verbal and written.
• Detail oriented with strong organizational skills.

Responsibilities

• Investigate background and credentials for practitioners and facilities contracted to provide care to Health Plan members.
• Direct and oversee primary source verification of credentialing elements.
• Summarize and report results to Medical Director and Credentialing Committee; provide written follow-up as required.
• Ensure processes comply with State, Federal and NCQA/CMS accreditation standards.

Skills

Communication skills

Attention to detail

Organizational skills

English proficiency

Education

High school diploma

1–3 years experience

Tools

MS Office

Job description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Job Summary

Position ensures thorough and accurate investigation of background and credentials for all practitioners and facilities contracted to provide care to Health Plan members. Position evaluates adequacy of information presented by all applicants for initial and re-credentialing, directing and overseeing primary source verification of all credentialing elements, and ensuring clarification of any discrepancies discovered in the verification process. Position accurately summarizes and reports the results of each investigation to the Medical Director and Plan Credentialing Committee, with written follow-up regarding credentialing determinations, as required. Position is also responsible for ensuring processes demonstrate compliance with State, Federal and National regulatory requirements and the accreditation standards of the National Committee for Quality Assurance (NCQA) and Medicare (CMS).

Benefit Highlights

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications and Requirements

• High school diploma or equivalent.
• 1 – 3 years related experience.
• Requires strong skills for communication in English, both verbally and in writing with provider applicants, applicants’ staff, the Medical Director, the Credentialing Committee, and other departments within the organization both verbally and in writing
• Must be highly detail oriented and requires strong organizational and prioritization skills, as well as the ability to complete job responsibilities of a confidential nature, with significant accountability and accuracy to meet established timelines
• One year physician office or related medical care experience required. Medical staff office experience preferred.
• Credentialing experience strongly preferred.
• Excellent computer skills including word-processing, databases, spreadsheets and graphics.
• Well-developed professional interpersonal written and oral communication skills.
• Strong medical terminology recommended.
• Strong organizational skills with the ability to prioritize multiple tasks/projects using established protocols and guidelines to determine the appropriate course of action and meet established timelines.
• Strong customer service skills that contribute to a customer-oriented team and department.
• Motivated, flexible, and a self-starter.
• Requires assertiveness, creativity and good problem-solving skills.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.