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The Credentialing Specialist is responsible for managing the credentialing and recredentialing process for client practitioners, including processing applications, performing primary source verifications, and ensuring enrollment with client health plans. This involves accurate data entry, updating provider information in databases, and monitoring expirations for licensure and certifications.
Requirements summary
Candidates must have 3-5 years of experience in medical credentialing processes, policies, and delegated credentialing requirements, along with proficiency in using various payor websites like CAQH, Pecos, and NPI/NPPES. An Associate's degree or equivalent education/experience combination is required, and certifications like CPCS or PESC are preferred.
Healthcare’s helping hand. CHG shook things up in 1979 by inventing the locum tenens staffing model. We connect doctors with patients who need their care. As the largest physician staffing firm in America, our providers treat millions of patients each year. Our industry is growing and demand is high. This means you’ll have plenty of opportunities to grow and develop in your career. Keeping healthcare healthy can be as fun as it is rewarding." The Credentialing Specialist is responsible for credentialing and recredentialing client practitioners as well as ensuring enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing credentialing applications, performing primary source verifications and updating and maintaining credentialing database in accordance with internal policies and procedures, client health plan contracts and applicable state and federal requirements. This is a temporary position, expected to last no more than one year. Responsibilities Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for payor enrollment and credentials verification process Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s) Enroll providers with client payors to include Medicare, Medicaid and state and federal commercial health plans and follow up as required until process complete Update CAQH and NPI information consistent with client practice information Responsible for gathering, verifying evaluating highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standards Respond to all practitioner, client health plan and internal inquiries in a timely manner Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed timeframe Maintain practitioner paper and electronic data files for clients; utilizing CAQH to submit practitioner data as required to credential individual practitioners Collaborate with participating clients in a professional manner, department manager and/or external agencies to facilitate and ensure smooth hand-off during the credentialing process Follow up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process Perform all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner files Conduct sanctions and compliance monitoring and alert Manager of any undisclosed negative findings immediately Participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency Contributes to positive culture Keep Manager informed of potential credentialing or enrollment issues Qualifications Proficient using payor websites including but not limited to CAQH, Pecos, NPI/NPPES, Availity, NaviNet, CMS I&A Proficiency ins using various software used for provider applications, verifying credentials and tracking verification statuses Proficient with payor enrollment process for all levels of licensure including but not limited to MD/DO, NP, PhD, PT, OT, LCSW, OD, DDS, DPM, etc. across all specialties including medical, dental, vision, behavioral health and physical health Knowledge of primary source verification--understand the process of verifying information directly from the original/authorized source that meets relevant regulations, accreditation requirements and compliance standards Experience should include 3-5 years of responsibility for medical credentialing processes, policies and procedures and delegated credentialing requirements Able to communicate clearly and concisely, both verbally and in written correspondence Able to work well under tight deadlines and respond to rapidly changing demands and provide efficient follow up Detail oriented with ability to recognize vital information from credentialing documents Demonstrate problem-solving, critical thinking, and deductive reasoning skills Ability to consistently maintain quality and production expectations Ability to learn and use credentialing database and other related databases Capable and comfortable dealing with sensitive and confidential information with discretion and trust Proficiency with MS Office suite Education & Experience Associate’s degree; or, an equivalent combination of education and/or experience Minimum of 3 years’ experience in provider credentialing in a healthcare setting Certified Provider Credentialing Specialist (CPCS) preferred Provider Enrollment Specialist Certificate (PESC) preferred We believe in fair compensation for all of our people, which is why our pay structure takes into account the cost of labor across U.S. geographic markets. For this position, we offer a pay of $25.00/hour. #LI-MJ1 In return, we offer:
Benefits
Flexible work schedules
Competitive pay
Work from home options
Award-winning training and development programs
Competitive pay
Flexible work schedules - including work from home options available
Award-winning training and development programs Click here to learn more about our company and culture. CHG Healthcare values a diverse and inclusive workforce. Interested in this role but not a perfect fit? Apply anyway. We welcome applicants of any race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status and individuals with disabilities as an Affirmative Action/Equal Opportunity Employer. We are an at-will employer. What makes CHG Different? You. Since founding the locum tenens industry in 1979, CHG Healthcare has been dedicated to serving the healthcare workforce and making a difference in human lives. Through our family of brands—CompHealth, Weatherby Healthcare, Global Medical Staffing, Locumsmart, Nursesmart, Modio, and CareerMD—we provide healthcare staffing solutions, including temporary and permanent placement of physicians and allied health professionals. We also offer credentialing services, innovative staffing technology, and career resources that connect employers with healthcare professionals. Learn more at chghealthcare.com.
