Credentialing Specialist

Dunhill Professional Search & Government Solutions; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

Dunhill Government Solutions is hiring a Credentialing Specialist to process credentialing and re-credentialing applications for healthcare practitioners supporting a federal military health program. You will verify credentials at the primary source and maintain CCQAS records while coordinating with treatment facilities and licensing agencies.

This is a full-time telework role. Responsibilities include PSV verifications, data loading, problem resolution, and ensuring regulatory compliance.

Qualifications

• High school diploma or GED.
• 2–5 years of physician credentialing experience in a medical group, hospital or health plan.
• Strong customer focus and interpersonal skills, plus written/verbal communication and computer skills.
• Excellent attention to detail and ability to manage multiple tasks.
• Ability to handle confidential information professionally.

Responsibilities

• Process credentialing and re-credentialing applications; review applications and prepare verification letters.
• Contact departments, licensing agencies and insurance carriers to complete credentialing and re-credentialing applications.
• Conduct Primary Source Verification (PSV) of licenses, certifications, registrations and education.
• Run queries through NPDB, DPDB, and DHHS/TRICARE sanction data banks.
• Load data into CCQAS and maintain up-to-date records.
• Research and resolve credentialing problems and escalate complex issues.
• Track credential status and provide documents for accession and privileging decisions.
• Maintain relationships with Military Treatment Facilities and supported customers.
• Ensure providers are credentialed, appointed and privileged with health plans and facilities.
• Review records for regulatory compliance and quality assurance.

Skills

Customer focus

Interpersonal skills

Collaboration

Written/verbal communication

Prioritization

Computer skills

Education

High school diploma or GED

Job description

Dunhill Government Solutions is hiring a Credentialing Specialist to process credentialing and re-credentialing applications for healthcare practitioners supporting a federal military health program. You will review applications, verify credentials at the primary source, keep credentialing records accurate and current, and work with treatment facilities, licensing agencies and insurance carriers to complete each file. This is a full-time telework role.

Responsibilities:

• Process credentialing and re-credentialing applications; review applications and prepare verification letters


• Contact departments, licensing agencies and insurance carriers to complete credentialing and re-credentialing applications


• Conduct Primary Source Verification (PSV) of licenses, certifications, registrations, professional school education, postgraduate, residency or specialty training, board certifications, work history and current references


• Run queries through the National Practitioner Data Bank (NPDB), the Defense Practitioner Data Bank (DPDB), and the Department of Health and Human Services (DHHS) and TRICARE sanction data banks


• Collect professional/peer references, completed clinical privileges, demographics, military and civilian practice history (including adverse privileging actions and malpractice history), health status, contingency and continuing education training, national provider identification numbers and, for non-personal services contract providers, malpractice insurance information


• Accurately load data into the Centralized Credentials Quality Assurance System (CCQAS), and establish and maintain up-to-date CCQAS records and documentation of applications and verifications


• Research and resolve credentialing/re-credentialing problems, escalating more complex issues as appropriate


• Track the status of practitioner credentials and provide the documents needed for accession, credentialing and privileging (C\&P) decisions


• Maintain relationships with Military Treatment Facilities and supported customers


• Ensure providers are credentialed, appointed and privileged with health plans, hospitals and patient care facilities


• Review records for regulatory compliance and quality assurance, ensuring relevant regulations are met

Required qualifications:

• High school diploma or GED


• 2-5 years of experience performing physician credentialing at a medical group, hospital or health plan


• Strong customer focus, interpersonal, collaboration, written/verbal communication, prioritization and computer skills


• Strong attention to detail and organization; able to handle multiple simultaneous tasks and complete work on schedule


• Able to handle confidential information daily in a professional manner, and to consistently maintain quality and production expectations


• Proof-reading skills sufficient for auditing documents


• Must be a US Citizen

Preferred qualifications:

• Bachelor's degree in a healthcare or business field


• Certified Provider Credentialing Specialist (CPCS)


• Knowledge of Department of Defense credentialing guidelines, policies and regulations


• Experience using CCQAS and the Defense Medical Human Resources System - internet (DMHRSi)

Location:

Full-time telework (US). No travel required.

Schedule:

Full-time, 40 hours/week, day shift.

US Citizenship and the ability to pass a federal background investigation in order to be granted access to sensitive information.