Medical Credentialing Specialist

Randstad; United States; On-site; USD 60,000 - 80,000; Full time

Job summary

Randstad is seeking a Managed Care Delegated Credentialing Specialist to join their dynamic team. This role involves verifying and maintaining healthcare providers' credentials, ensuring compliance with standards, and collaborating across departments. Candidates should have relevant experience or an associates degree, strong organizational skills, and proficiency in Microsoft Office. Join us for a rewarding career in managed care!

Qualifications

• Experience with NCQA guidelines.
• CPCS or CPMSM certified (within the year of employment).
• Experience in healthcare or health insurance.

Responsibilities

• Manage the full cycle of provider credentialing and re-credentialing.
• Maintain compliance with accrediting and regulatory agencies.
• Collaborate with provider representatives and support audits.

Skills

Organizational skills

Attention to detail

Analytical skills

Problem-solving skills

Education

Associates degree or 3 years of experience in health insurance

Tools

Microsoft Office Suite

Adobe

Job description

This range is provided by Randstad. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$20.00/hr - $29.00/hr

Direct message the job poster from Randstad

Managed Care Credentialing Specialist - Join Our Team!

Join our dynamic team and advance your career as a Managed Care Delegated Credentialing Specialist! We offer a challenging and rewarding opportunity to contribute to a high-performing organization.

As a Managed Care Delegated Credentialing Specialist you will focus on verifying and maintaining the credentials of healthcare providers within a managed care organization, ensuring they meet the necessary qualifications and standards to participate in the network. This role involves managing the delegated credentialing process, where the health plan authorizes another entity (like a hospital or CVO) to handle credentialing on their behalf. They ensure compliance with regulatory requirements, maintain accurate provider information, and often work with various departments to facilitate efficient credentialing processes.

As a Credentialing Specialist, you will:

• Manage the full cycle of provider credentialing and re-credentialing, from application collection to database entry.
• Play a key role in maintaining compliance with accrediting and regulatory agencies.
• Collaborate with provider representatives, support audits, and identify process improvements.
• Verification of physician's privileges

What We Offer:

• A supportive team environment where your contributions are valued.
• Opportunities to develop your skills and expand your knowledge of managed care operations.
• A commitment to professional growth and excellence.
• Pay range $20-29 per hour
• Contract-to-hire possibility after 3 months.

What You Bring:

• Associates degree or 3 years of experience in the field of health insurance (HMO, health insurer, TPA, broker, Quality Assurance, physician practice or healthcare setting) sufficient to yield the knowledge requirements.
• Experience with NCQA guidelines
• Verification of physician's privileges
• Excellent organizational, planning, and time management skills.
• Strong attention to detail, analytical, and problem-solving skills.
• Proficiency in Microsoft Office Suite.
• Proficiency with Adobe
• Experience in healthcare or health insurance.
• Experience in health insurance or a healthcare setting.
• CPCS or CPMSM certified (Must be certified within the year of employment)

If you are a motivated and detail-oriented individual seeking a rewarding career in managed care, we encourage you to apply!

FOR MORE IMMEDIATE CONSIDERATION, email a current resume to [e-mail]

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Administrative, Accounting/Auditing, and Health Care Provider

• Industries

  Medical Practices, Hospitals and Health Care, and Hospitals

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