Job description
Credentialing Specialist
We are actively seeking an experienced and strategic professional to take on the role of Credentialing Specialist. This role provides a significant learning & growth opportunity for someone who is looking to expand their experience in consultative credentialing services working with top talent across the globe.
Key Responsibilities:
- Process physician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing
- Daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources
- Analyze local payor IPA markets for partnerships or payer contracting opportunities
- Perform primary source verification via various state and national sources
- Oversees, updates and maintains provider credential database including CAQH, PECOS, NPPES Registry, Sharepoint any other applicable regulatory agencies
- Develops and prepares analytical reports monthly/quarterly of the summary of credentialing activity
- Responds timely to provider inquiries by letter, phone or internal communication
- Work closely and maintain relationships with provider relations at each payer, and communicates any challenges and/or concerns with manager timely
- Mentor and coach the team to provide highest levels of service and efficiency
- Maintain relationships with key Payers to facilitate negotiation of contracts
- Collaborate with internal departments to streamline and optimize credentialing operations.
- Manage client relationships and provide high customer satisfaction
- Develop and implement policies and procedures to maintain the highest standards of credentialing excellence in the internal teams.
- Stay informed about changes in accreditation and certification requirements and update processes accordingly.
- Provide thought leadership via adoption of best practices based on industry changes and technology adoption.
Qualifications:
- Bachelor’s degree in healthcare administration, Business, or a related field; master’s degree preferred.
- 2 - 3 years of experience in credentialing, with substantial experience in a leadership role.
- In-depth knowledge of credentialing processes, privileging, and regulatory requirements.
- Established relationship with key payers will be a plus
- Strong organizational and project management skills.
- Excellent communication skills
- Skilled in preparing and delivering presentations to C Suite stakeholders.
If you are a dynamic leader with a proven track record in credentialing and are ready to make a significant impact on our organization, we want to hear from you! Join us in the heart of Chicago and be part of a collaborative and innovative healthcare environment.
To apply, submit your resume to [email protected] with the subject line “Credentialing Specialist”
#JobOpportunity #HealthcareManagement #Credentialing #CVO #Credentialing
Job Type: Full-time
Benefits:
- Health insurance
Schedule:
- 8 hour shift
Work Location: Hybrid/Remote
