Credentialing Specialist I

Cure 4 The Kids; Las Vegas (NV); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Competitive compensation package

Comprehensive benefits

Job summary

Cure 4 The Kids Foundation in Las Vegas, NV is seeking a Credentialing Specialist I to coordinate credentialing, privileging, re-credentialing, and payer enrollment for all providers in a fast-paced clinical environment.

The role requires a high school diploma or GED and at least two years of credentialing experience; CPCS certification is preferred. You will maintain licenses, perform primary source verification, and support accreditation readiness with accuracy and integrity.

Qualifications

• High school diploma or GED.
• At least two years of provider credentialing or medical staff services experience (recent).

Responsibilities

• Manage provider credentialing, privileging, and re-credentialing including hospital applications.
• Complete payer enrollment and CAQH profiles updates.
• Maintain licenses, DEA certificates, malpractice coverage and renewals.
• Perform primary source verification and sanction checks.
• Maintain credentialing binders and update online databases.
• Support accreditation readiness and process improvements.

Skills

Interpersonal and communication skills

Attention to detail

Independent work

Research and data analysis

Computer skills (Word, Excel, PowerPt)

Credentialing standards knowledge

Education

High school diploma or GED

Certified Provider Credentialing Specialist (CPCS) certification

Tools

Word

Excel

PowerPoint

Practice management software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Credentialing Specialist I

Credentialling Full Time Las Vegas, NV, US

3 days ago Requisition ID: 1533

We don't train our people to be nice... We simply hire nice people

We are looking for the brightest and the best to join our team!

Are you looking for a career in a high-paced, complex, and collaborative clinical environment?

Two major benefits offered by Cure 4 The Kids Foundation

• One of the most competitive compensation and comprehensive benefit packages in the field of healthcare
• A state-of-the-­art clinical and administrative environment located at 215 and Town Center, Summerlin on the Roseman University Campus

Cure 4 The Kids Foundation was voted #10 on the list of the Best Non-Profits to Work For in the U.S.

What it takes to be part of our team

Are you an exceptional Credentialing Specialist who can interact comfortably with direct and candid physicians as well as easier going personality types? Do you like to be busy and want to be part of a fast paced and accountable team? Can you dedicate yourself to being part of a team serving the needs of children and their families? Can you multi-task with a sense of purpose and urgency when needed? Do you absolutely thrive on being part of an accountable team serving the needs of children and their families? Do you bring the highest standards of integrity and professionalism to your team? Do you thrive in an environment where you are valued and appreciated for who you are, how hard you work and for that something special you bring to the teams you choose to work with? Are you looking for an organization that offers competitive compensation and one of the broadest and most comprehensive benefit packages available in the field of healthcare?

If you said yes to all of these questions and feel you can add to our culture, please keep reading…

This is a role that requires a multi-disciplinary team approach to solving problems and patient challenges. "That's not my job" or "someone else can do it" is not in our team vocabulary because we are here to be of support to each other. The primary goal is to bring the best patient care and experience for our area's children.

This role within our team is mission critical to the health and safety of the children we see every day at our clinic. The primary goal of every team member is to bring the best patient care and experience for our area's sickest children. If you feel inspired by what you have read so far, read on.

SUMMARY: Coordinate credentialing, privileging, re-credentialing, and payer enrollment for all providers while maintaining accurate, survey-ready files. The Credentialing Specialist I works independently within established policies while escalating complex findings to the Credentialing Specialist II. This is a non-exempt, hourly position.

ESSENTIAL ACCOUNTABILITY AND EXPECTATIONS:

• Maintain a high level of professionalism and always project this to the Board, all team members (employed and volunteers), parents/patients, partners and stakeholders.
• Create and maintain good working relationships with organizational leaders and team members.
• Build relationships that will support patient needs and appeal to new patients and organizations.
• Check emails and respond in a timely manner.
• Participate in mandatory training.
• Create and maintain a gossip free environment.
• Maintain a clean and safe working environment.
• Knows, aligns with, and strives to achieve the organization’s vision and mission statements via The C4K Way.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Manage internal and external provider credentialing, privileging, and re-credentialing, including area hospital applications; monitor applications and contracts to completion.
• Complete payer enrollment, revalidation, and updates for all providers, including maintaining Council for Affordable Quality Healthcare (CAQH) profiles and attestations and updating payer portals.
• Maintain current copies of state licenses, Drug Enforcement Administration (DEA) certificates, malpractice coverage, and other required credentialing documents for all providers; manage all license renewals.
• Conduct license monitoring process for all providers in accordance with License and Certification Verification policy to include initiation of letters, reports, and primary source verification of renewals.
• Perform primary source verification and exclusion and sanction checks in accordance with organizational policy.
• Review credentialing files independently for completeness and accuracy, identify missing, expired, or concerning items, document follow-up and resolution, and elevate issues to the Credentialing Specialist II as needed.
• Create and maintain provider and staff credentialing binders and ensure all required information is accurately maintained in online credentialing databases.
• Ensure practice information is current and accurate with health plans, payer portals, facilities, and other entities.
• Update payer and provider credentialing information in the practice management software and communicate relevant updates to the appropriate personnel.
• Maintain, update, and create physician privileges and credentialing forms, in coordination with the Credentialing Specialist II.
• Support accreditation readiness efforts led by the Credentialing Specialist II, including file audits, checklists, and preparation for unannounced surveys.
• Document credentialing workflows, support process improvements efforts, and test new processes and tools, including AI, providing actionable feedback.
• Provides support and assistance with special projects and departmental initiatives.
• Perform other duties as assigned.

REQUIRED EDUCATION AND EXPERIENCE:

• High school diploma or GED.
• A minimum of two (2) years of provider credentialing or medical staff services experience in the past five (5) years, including primary source verification, license and expirable tracking, and re-credentialing.

PREFERRED EDUCATION AND EXPERIENCE:

• Certified Provider Credentialing Specialist (CPCS) certification.
• Hospital medical staff or payer enrollment experience, including CAQH.
• Direct experience with Joint Commission credentialing and privileging standards or survey support.
• Experience with credentialing databases and practice management software.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Working knowledge of credentialing standards, including Joint Commission, state, and payer requirements, and primary source verification.
• Computer skills including Word, Excel, PowerPoint, and the ability to learn and utilize all proprietary software programs.
• Strong interpersonal and communication skills, both written and oral, with varying levels of colleagues, management, providers, and external entities such as health plans and state regulatory bodies.
• Attention to detail and strong organizational skills managing multiple priorities that require consistent follow-up.
• Ability to work independently with minimal supervision, elevate concerns appropriately, and adapt to change.
• Ability to research, analyze data, and organize findings.

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

• Frequent sitting and prolonged computer use, including repetitive keyboarding and mouse operation.
• Frequently required to handle several face-to-face telephone contacts daily.
• Frequently required to utilize visual acuity to operate office equipment and use a keyboard.
• Occasionally required to stand, walk, bend, reach, lift, or carry items up to 10 pounds.

CURE 4 THE KIDS FOUNDATION PARTICIPATES IN E-VERIFY