Credentialing Specialist | NCQA & Compliance Focus

Prominence-Health-Plan; Reno (NV); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive Compensation

Generous Paid Time Off

Excellent Medical, Dental, Vision

401(K) with company match

Stock plan discounts

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health is seeking a Credentialing Specialist to thoroughly investigate and verify credentials for practitioners and facilities contracted to the plan. You will direct primary source verification, summarize findings for the Medical Director and Credentialing Committee, and ensure compliance with state, federal, NCQA, and CMS standards.

Strong attention to detail and English communication are essential.

Qualifications

• High school diploma or equivalent is required.
• 1–3 years related experience, credentialing experience preferred.
• Strong English communication, written and verbal, with providers and committees.
• Detail oriented with organizational skills and ability to manage timelines.
• Experience in physician offices or medical care settings is preferred.
• Proficient computer skills including word processing, databases, spreadsheets and graphics.
• Strong interpersonal, written and oral communication skills; good medical terminology recommended.

Responsibilities

• Investigate background and credentials for practitioners and facilities contracted to the plan.
• Direct and oversee primary source verification of credentialing elements.
• Summarize and report investigation results to Medical Director and Credentialing Committee.
• Ensure compliance with State, Federal, NCQA and CMS accreditation standards.
• Maintain timelines and handle confidential information with accuracy.

Skills

English communication

Detail oriented

Organizational skills

Prioritization

Confidentiality

Healthcare credentialing

Credentialing experience

Interpersonal skills

Medical terminology

Customer service

Self-starter

Problem solving

Education

High school diploma or equivalent

Tools

Word processing

Databases

Spreadsheets

Graphics

Job description

Prominence Health is seeking a Credentialing Specialist to thoroughly investigate and verify credentials for practitioners and facilities contracted to the plan. You will direct primary source verification, summarize findings for the Medical Director and Credentialing Committee, and ensure compliance with state, federal, NCQA, and CMS standards.

Strong attention to detail and English communication are essential.