Provider Credentialing Specialist

Accede Solutions Inc (accedesolution.com); United States; On-site; USD 42,000 - 62,000; Full time

Job summary

Accede Solutions Inc. is seeking a Provider Credentialing Representative to manage day-to-day credentialing activities for healthcare providers, ensuring regulatory and payer requirements are met.

You will handle PSV, initial and re-credentialing, gather documentation, maintain records, and prepare files for committee review, while meeting productivity and quality expectations.

Qualifications

• High school diploma required.
• Associate's or Bachelor's degree preferred.
• 2+ years of healthcare credentialing experience preferred.
• Knowledge of PSV and credentialing processes.

Responsibilities

• Process initial credentialing applications.
• Process re-credentialing applications.
• Perform Primary Source Verification (PSV).
• Review provider applications for accuracy and completeness.
• Request missing documentation from providers.
• Verify licenses, board certifications, DEA, malpractice coverage, education, and work history.
• Maintain accurate provider records within the credentialing system.
• Prepare provider files for committee review.
• Track credentialing deadlines and follow up on outstanding items.
• Communicate with providers regarding credentialing requirements.
• Escalate issues that may delay credentialing completion.
• Ensure compliance with CMS, NCQA, and organizational standards.
• Assist with audits and quality reviews.
• Maintain confidentiality of provider information.
• Meet departmental productivity and quality expectations.

Skills

Attention to detail

Organizational skills

Verbal and written communication

Education

High school diploma

Associate's degree

Bachelor's degree

Job description

The Provider Credentialing Representative is responsible for performing day-to-day credentialing activities to ensure healthcare providers meet all regulatory, payer, and organizational requirements. This position completes credentialing and re-credentialing activities, performs Primary Source Verification (PSV), prepares provider files for committee review, and maintains accurate provider records.

• Process initial credentialing applications.
• Process re-credentialing applications.
• Perform Primary Source Verification (PSV).
• Review provider applications for accuracy and completeness.
• Request missing documentation from providers.
• Verify licenses, board certifications, DEA, malpractice coverage, education, and work history.
• Maintain accurate provider records within the credentialing system.
• Prepare provider files for committee review.
• Track credentialing deadlines and follow up on outstanding items.
• Communicate with providers regarding credentialing requirements.
• Escalate issues that may delay credentialing completion.
• Ensure compliance with CMS, NCQA, and organizational standards.
• Assist with audits and quality reviews.
• Maintain confidentiality of provider information.
• Meet departmental productivity and quality expectations.

Qualifications

• High school diploma required; Associate's or Bachelor's degree preferred.
• 2+ years of healthcare credentialing experience preferred.

Knowledge of:

• Initial Credentialing
• Re-credentialing
• Primary Source Verification (PSV)
• Healthcare credentialing documentation

• Strong attention to detail.
• Excellent organizational skills.
• Strong verbal and written communication skills.