Credentialing Specialist I

Health Choice Network; United States; Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated professional to manage credentialing processes for healthcare providers. This role involves ensuring compliance with regulatory standards while supporting the credentialing committee's efforts. Ideal candidates will have a strong background in healthcare, proficiency in various software tools, and a clear understanding of the credentialing process. The organization offers a flexible work environment and comprehensive benefits, including medical and retirement plans, making it a great opportunity for those looking to advance their careers in the healthcare sector.

Benefits

Flexible work environment

Medical, Dental, Vision and Life Insurance

403B Retirement Plan

Generous Paid Time Off

Pet Insurance

Health Savings Account contributions

Qualifications

• 5+ years of experience in healthcare credentialing.
• Associate's Degree in Health Care Administration or equivalent experience.

Responsibilities

• Oversee the credentialing process for medical and health professional staff.
• Ensure compliance with regulatory bodies and verify provider information.

Skills

Credentialing Process Knowledge

Contact Management Systems

Database Software

Microsoft Office Applications

Healthcare Industry Familiarity

Education

Associate's Degree in Health Care Administration

5 years of relevant experience

Tools

Spreadsheet Software

Word Processing Software

Job description

Who We Are

We’re a family of health centers, supported by a family of Associates.

For over 25 years, Health Choice Network (HCN) has been an employer of choice in South Florida, supporting health centers, patients, and the communities they serve. We are one of the first successful health center-controlled networks and our success is due largely to our Associates and their commitment to advancing our mission to improve the health status of our communities.

What We Are Looking For

This position is primarily responsible for processing credentialing and re-credentialing applications of healthcare providers, enforces regulatory compliance and quality assurance.

Position Expectations

• Oversee the comprehensive initial and re-credentialing process for medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers. Ensure strict compliance with regulatory bodies, including Joint Commission, NCQA, URAC, CMS, AAHC, Medicaid, and Medicare.
• Thoroughly complete, review, and analyze provider credentialing applications and accompanying documents to ensure accuracy and completeness.
• Utilize a variety of reputable sources, such as NPDB, ABMS, AOIA, EPLS, Opt-Out, Florida Department of Health, and Office of Inspector General, to verify information on applications, ensuring a reliable credentialing process.
• Provide valuable support and active participation in HCN Credentialing Committee Meetings, contributing to the overall success of the credentialing process.
• Additional duties and responsibilities assigned.

Skills and Abilities for Success

• Proficiency in Contact Management Systems, Database software, Internet software, Spreadsheet software, and Word Processing software, enabling efficient and organized credentialing operations.
• Tech Savviness: Demonstrated knowledge of PC usage, Windows, and Microsoft Office applications, facilitating seamless daily tasks.
• Familiarity with the Healthcare and/or Community Health Center industry and practices, contributing to a comprehensive understanding of the healthcare landscape.
• Clear Understanding of Credentialing Process: Possess in-depth knowledge of the credentialing process, ensuring accurate and compliant credentialing procedures.
• Additional skills required for success.

Education, Experience and Certifications

• A minimum of 5 years of relevant experience in a healthcare-related position and/or an Associate's Degree in Health Care Administration, Business Administration, or a related field, or equivalent combined experience.
• Preferred experience working in a Health Care Organization, demonstrating a solid foundation in the healthcare industry.
• Preferred Credentialing Certification, showcasing advanced expertise and commitment to the credentialing field.

Health Choice Network Perks and Benefits

• Flexible work environment.
• Medical, Dental, Vision and Life Insurance plans with employer contributions up to 100% on some of the provider plans, including dependents. HCN contributes $125.00 a month towards eligible associates Health Savings Account.
• 403B Retirement Plan that contributes 5% on an annual basis after a year of service for eligible associates.
• Generous Paid Time Off, plus an additional 8 paid Federal Holidays per year.
• Pet Insurance.

Health Choice Network is an equal opportunity/affirmative action employer and complies with all federal and state laws, regulations and executive orders regarding affirmative action requirements in all programs.

HCN is a drug-free workplace.