Delegated Credentialing Specialist

The Ohio State University Wexner Medical Center; Columbus (OH); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

An array of retirement plan options with employer contributions

Affordable health insurance options

Paid vacation and sick leave

Public Service Loan Forgiveness program

Job summary

A prominent healthcare institution in Ohio is seeking a Delegated Credentialing Specialist to oversee the credentialing of providers. This role requires a Bachelor's degree and four years of experience in a hospital or managed care setting. Strong communication and organizational skills are essential. The position offers comprehensive health benefits, retirement options, and more. Join our team and contribute to ensuring healthcare practices meet the highest standards.

Qualifications

• 4 years experience in a hospital setting and/or managed care setting.
• Knowledge of NCQA and JCAHO standards for credentialing.
• Ability to work independently with minimal supervision.

Responsibilities

• Manage the provider corporate credentialing functions from hire to enrollment.
• Assure compliance with NCQA and JCAHO standards.
• Enroll providers into governmental and non-delegated health plans.

Skills

Strong verbal and written communication skills

Strong organizational skills

Ability to problem solve

Education

Bachelor's degree in health related or educational field

Tools

Microsoft Word

Excel

Job description

Overview

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Scope Of Position

The Credentialing Specialist will assume total responsibility of credentialing of providers from hire to enrollment in managed care plans. The Credentialing Specialist provides services for all entities within the healthcare system.

Position Summary

Primary responsibility will be initiating and monitoring the provider corporate credentialing functions to assure that all practitioners are credentialed in accordance with established thresholds. This includes primary source verification and medical staff privileging, assuring compliance with NCQA and JCAHO standards. Also, responsibility will include enrollment into governmental payor plans (Medicare, Medicaid, Bureau of Workers Compensation, etc.) and enrollment into other non-delegated health plans. CVO Specialist may also be asked to work on special projects for providers, which might include assisting with credentialing process for other healthcare institutions when a business relationship exists. This position requires excellent verbal and written communication skills and the ability to work independently, while managing multiple priorities.

Required Qualifications

• Bachelor\'s degree in health related or educational field
• 4 years experience in a hospital setting and/or managed care setting or equivalent combination of education and experience
• Strong verbal and written communication skills; Strong organizational skills and attention to detail
• Ability to work with minimal supervision and to maintain confidentiality due to access to sensitive information
• Ability to problem solve and think creatively
• Knowledge of NCQA and JCAHO as they relate to current credentialing and re-credentialing standards
• Working knowledge of Microsoft Word and Excel
• CPMSM or CPCS certification preferred

Benefits

• An array of retirement plan options, each with a generous employer contribution.
• Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.
• Paid vacation and sick leave, including short and long-term disability and paid parental leave.
• Get the most out of the Public Service Loan Forgiveness program.
• And much more!

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process. The university is an equal opportunity employer, including veterans and disability.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care