Credentialing Specialist: NCQA & CMS Compliance Expert

Henderson Hospital; Reno (NV); On-site; USD 60,000 - 75,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Generous Paid Time Off

Excellent Medical, Dental, Vision and药

401(K) with company match

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health seeks a Credentialing Coordinator to thoroughly investigate backgrounds and credentials for practitioners and facilities contracted to provide care to Health Plan members. You will direct primary source verification and ensure accuracy and compliance with NCQA and CMS standards, reporting findings to the Medical Director and Credentialing Committee.

The role requires strong English communication, meticulous attention to detail, and the ability to meet timelines in a fast-paced

Qualifications

• Must have credentialing experience and be able to verify primary source documents.
• Strong written and verbal English communication with medical staff and committees.
• Detail-oriented with organizational skills and ability to meet timelines.
• One year physician office or related medical care experience preferred.
• Proficient computer skills including word processing, databases, spreadsheets and graphics.

Responsibilities

• Perform thorough investigation of background and credentials for practitioners and facilities.
• Direct and oversee primary source verification of credentialing elements.
• Summarize and report verification results to Medical Director and Credentialing Committee.
• Ensure processes comply with State, Federal and NCQA/CMS accreditation standards.

Skills

Credentialing experience

English communication

Attention to detail

Medical staff office experience

Computer skills

Organizational skills

Customer service

Self-starter

Education

High school diploma or equivalent

Job description

Prominence Health seeks a Credentialing Coordinator to thoroughly investigate backgrounds and credentials for practitioners and facilities contracted to provide care to Health Plan members. You will direct primary source verification and ensure accuracy and compliance with NCQA and CMS standards, reporting findings to the Medical Director and Credentialing Committee.

The role requires strong English communication, meticulous attention to detail, and the ability to meet timelines in a fast-paced