Credentialing Specialist – Ensure Compliance & Quality Care

Aiken Regional Medical Centers; Reno (NV); On-site; USD 65,000 - 80,000; Full time

Benefits offered by this job

Loan Forgiveness

Paid Time Off

Medical, Dental, Vision plans

401(K) with company match

SoFi Student Loan Refinancing

Career development opportunities

Job summary

Prominence Health, part of Universal Health Services, seeks a Credentialing Specialist to thoroughly investigate and verify credentials for practitioners and facilities contracted to serve Health Plan members. You will direct primary source verifications, resolve discrepancies, and summarize findings for the Medical Director and Plan Credentialing Committee.

You will ensure compliance with State, Federal and NCQA/CMS accreditation standards, maintain timely verifications, and support a compliant

Qualifications

• High school diploma or equivalent.
• 1 – 3 years related experience.
• Strong 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.

Responsibilities

• Conduct thorough and accurate investigation of background and credentials for all practitioners and facilities contracted to provide care to Health Plan members.
• Direct and oversee primary source verification of all credentialing elements and clarify discrepancies identified in the verification process.
• Summarize and report investigation results to the Medical Director and Plan Credentialing Committee, with follow-up regarding credentialing determinations as required.
• Ensure processes demonstrate compliance with State, Federal and National regulatory requirements and NCQA and CMS accreditation standards.

Skills

Communication skills

Detail oriented

Organizational skills

Customer service

English proficiency

Education

High school diploma or equivalent

Tools

Word processing

Databases

Spreadsheets

Graphics

Job description

Prominence Health, part of Universal Health Services, seeks a Credentialing Specialist to thoroughly investigate and verify credentials for practitioners and facilities contracted to serve Health Plan members. You will direct primary source verifications, resolve discrepancies, and summarize findings for the Medical Director and Plan Credentialing Committee.

You will ensure compliance with State, Federal and NCQA/CMS accreditation standards, maintain timely verifications, and support a compliant