Senior Credentialing & Compliance Specialist (Facilities)

HealthFirst; Wyoming (MI); Presencial; USD 45.000 - 65.000; Jornada completa

Descripción de la vacante

HealthFirst’s Credentialing department verifies and re-verifies providers, facilities, and vendors, maintains directory accuracy, and ensures compliance with federal and state regulations. The role prepares materials for meetings, conducts audits, processes directories with third party vendors, communicates with internal teams, and seeks process improvements to meet regulatory standards.

A strong candidate has HS diploma, credentialing experience, and solid MS Office skills; preferred bachelor’s

Formación

• HS diploma or GED required.
• Facility credentialing experience is required.
• Bachelor’s degree preferred.
• Prior credentialing experience is a plus.
• Strong time and project management, critical/creative thinking, communication, and problem-solving skills.
• Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint) and Adobe is preferred.

Responsabilidades

• Credentials providers, facilities, and vendors in accordance with regulations and HealthFirst policy.
• Prepares presentations for quarterly credentialing and delegate vendor oversight committee meetings.
• Facilitates pre-delegation and delegation vendor audits to ensure adherence to contractual arrangements.
• Prepares hard-copy directories and coordinates with third-party vendors for online directories.
• Reviews relevant data to ensure accuracy.
• Effectively communicates with internal departments and external partners.
• Identifies and assesses opportunities to improve processes to ensure regulatory compliance and adherence to state and federal regulations.
• Raises issues to management and assists in resolution.
• Additional duties as assigned.

Conocimientos

Time management

Project management

Critical thinking

Communication

Problem solving

Attention to detail

Educación

HS diploma/GED

Bachelor’s degree

Herramientas

Microsoft Office

Adobe

Access

Excel

Word

PowerPoint

Descripción del empleo

HealthFirst’s Credentialing department verifies and re-verifies providers, facilities, and vendors, maintains directory accuracy, and ensures compliance with federal and state regulations. The role prepares materials for meetings, conducts audits, processes directories with third party vendors, communicates with internal teams, and seeks process improvements to meet regulatory standards.

A strong candidate has HS diploma, credentialing experience, and solid MS Office skills; preferred bachelor’s