Healthcare Provider Credentialing Specialist

Point32Health, Inc.; Massachusetts; Sur place; USD 60 000 - 85 000; Plein temps

Résumé du poste

Point32Health, Inc. is hiring a Credentialing Specialist to ensure affiliated physicians and practitioners meet state laws, NCQA, and organizational policies. You will handle credentialing applications, verify licenses, and review sanctions to maintain provider eligibility.

The role involves preparing files for review by Credentialing Supervisors and Medical Directors, and aiding in data management within the provider network. Strong attention to detail and healthcare familiarity are essential.

Qualifications

• High school diploma or higher required.
• 1-2 years healthcare credentialing experience preferred.
• Experience with credentialing processes a plus.
• Familiarity with NPDB reviews and sanctions is helpful.

Responsabilités

• Maintain and process credentialing information for new and established health plan practitioners.
• Enter initial and existing credentialing applications into the Cactus system.
• Verify licenses, board certifications, and other credentials.
• Review adverse information from NPDB and state/federal sanctions.
• Prepare credentialing files for daily review by supervisors and Medical Directors.

Connaissances

Multitasking

Attention to detail

Communication

Formation

High school diploma

Bachelor’s degree

Outils

Cactus credentialing system

Microsoft Word

Microsoft Excel

Description du poste

Point32Health, Inc. is hiring a Credentialing Specialist to ensure affiliated physicians and practitioners meet state laws, NCQA, and organizational policies. You will handle credentialing applications, verify licenses, and review sanctions to maintain provider eligibility.

The role involves preparing files for review by Credentialing Supervisors and Medical Directors, and aiding in data management within the provider network. Strong attention to detail and healthcare familiarity are essential.