Provider Credentialing Specialist Vetting & Compliance

Priority Management Group; Pawtucket (RI); Presencial; USD 42.000 - 65.000; Jornada completa

Descripción de la vacante

Priority Management Group in Pawtucket, RI is seeking a Credentialing Specialist to process initial credentialing and re-credentialing applications in accordance with federal and state regulations. You will screen applications, verify information, maintain the credentialing database, and communicate status with providers while upholding HIPAA policies and delivering excellent service.

The role requires strong attention to detail, excellent organizational skills, and the ability to work

Formación

• High school diploma or GED is required; associate degree preferred.
• Experience in a medical office/healthcare setting is a plus.
• HIPAA, PMG policies, and federal/state laws compliance is required.
• Proficient with Microsoft Excel and Adobe Acrobat.
• Excellent communication and organizational skills.

Responsabilidades

• Process credentialing and re-credentialing applications using defined processes.
• Screen applications and supporting documents for eligibility.
• Investigate discrepancies and verify information from primary sources.
• Provide status responses to external inquiries about providers.
• Maintain credentialing database with current provider information.
• Maintain confidentiality regarding disciplinary actions and malpractice suits.
• Assist the team with additional administrative tasks as assigned.

Conocimientos

Administrative experience

HIPAA compliance

Customer service

Attention to detail

Teamwork

Interpersonal skills

Problem solving

Educación

High School Diploma or GED

Associate degree (preferred)

Herramientas

Microsoft Office Suite (Excel)

Adobe Acrobat

Descripción del empleo

Priority Management Group in Pawtucket, RI is seeking a Credentialing Specialist to process initial credentialing and re-credentialing applications in accordance with federal and state regulations. You will screen applications, verify information, maintain the credentialing database, and communicate status with providers while upholding HIPAA policies and delivering excellent service.

The role requires strong attention to detail, excellent organizational skills, and the ability to work