Credentialing Specialist I

Important things YOU should know?

• Fully remote opportunity

• Schedule: Monday - Friday - 7:30am - 4:00pm CST

• Flex Schedule Potential

What will YOU be doing? Ensures organization meets all necessary requirements in credentialing and re-credentialing medical, dental, therapy, and vision providers according to client and NCQA guidelines.

What will YOU be working on?

• Verify provider credentials according to product and quality guidelines for provider acquisition and re-credentialing.

• Prepare provider files for review.

• Ensure accuracy of provider information in credentialing systems by matching provider entered data with all credentialing documents.

• Recommend system enhancements and process improvements.

• Respond to provider inquiries related to the credentialing process

• Perform outreach to providers to obtain completed credentialing applications.

Additional Responsibilities:

• Assist with administrative duties as assigned.

• Assist in annual NCQA accreditation process.

• Assist with answering credentialing phone line.

• Perform outreach to providers to obtain completed credentialing applications.

What qualifications do YOU need to have to be a GOOD candidate?

• Required Level of Education, Licenses, and/or Certificates

  • High school diploma or equivalent

• Required Level of Experience

  • 1+ years of experience in administrative role, office environment, billing or other related experience.

• Required Knowledge, Skills, and Abilities

  • MS Office Suite such as Word, Excel and Outlook.

  • Demonstrated successful typing skills

  • Ability to remain organized and meet multiple conflicting deadlines

  • Attention to detail

  • Ability to place successful outreach phone calls

What qualifications do YOU need to have to be a GREAT candidate?

• Preferred Level of Education, License, and/or Certificates

  • Associates Degree or higher in a related field

• Preferred Level of Experience

  • 1+ years of experience in a healthcare environment

  • 1+ years of Provider Relations or Credentialing