Credentialing Specialist: Provider Verification

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

Benefits offered by this job

Loan Forgiveness Program

Competitive compensation & generous PT

Excellent Medical, Dental, Vision and

Job summary

Prominence Health, a value-based care organization under Universal Health Services, is seeking a Credentialing Specialist to ensure thorough investigation of practitioner and facility credentials contracted to provide care to Health Plan members.

You will oversee primary source verification, clarify discrepancies, and report results to the Medical Director and Credentialing Committee while ensuring compliance with NCQA and CMS standards.

Qualifications

• Must communicate effectively in English, both verbally and in writing.
• Highly detail oriented with strong organizational and prioritization skills.
• Ability to handle confidential information with accuracy and timeliness.

Responsibilities

• Conduct thorough background and credentialing investigations for all contracted practitioners and facilities.
• Direct and oversee primary source verification of credentialing elements.
• Summarize and report results to Medical Director and Credentialing Committee with written follow-up.
• Ensure processes comply with State, Federal, NCQA and CMS accreditation standards.

Skills

English communication

Detail oriented

Organizational skills

Prioritization

Problem solving

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

Prominence Health, a value-based care organization under Universal Health Services, is seeking a Credentialing Specialist to ensure thorough investigation of practitioner and facility credentials contracted to provide care to Health Plan members.

You will oversee primary source verification, clarify discrepancies, and report results to the Medical Director and Credentialing Committee while ensuring compliance with NCQA and CMS standards.