Medical Credentialing Specialist presso undefined

We are seeking a full-time Credentialing Coordinator/Specialist to manage the credentialing and re-credentialing process for 132 providers across 12 facilities. This role is critical in ensuring compliance with regulatory standards, payer requirements, and organizational policies. The Credentialing Coordinator/Specialist will maintain organized workflows, verify provider credentials, and collaborate with key stakeholders to uphold high-quality care standards across all facilities.

Key Responsibilities:

• Manage credentialing and re-credentialing for 132 providers across 12 facilities, ensuring timely submissions and updates.
• Verify and process provider credentials, including licensure, certifications, education, and work history.
• Maintain accurate and up-to-date records in credentialing databases and software.
• Coordinate with providers, payers, and facility administrators to resolve discrepancies or delays.
• Ensure compliance with all applicable federal, state, and organizational regulations.
• Prepare and submit applications for payer enrollment, hospital privileges, and re-credentialing as needed.
• Collaborate with cross-functional teams to support operational and regulatory goals.
• Monitor expiring credentials and notify providers of renewal deadlines.
• Generate reports to track credentialing progress and meet organizational objectives.

Qualifications:

• High school diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration or related field preferred.
• Minimum of 2 years of credentialing experience in a healthcare setting.
• Knowledge of NCQA, JCAHO, and CMS standards.
• Familiarity with payer enrollment processes.
• Proficient in Microsoft Office Suite and credentialing software (e.g., CAQH, MD-Staff).
• Exceptional organizational skills and attention to detail.
• Strong communication and problem-solving abilities.
• Ability to work independently and meet tight deadlines.

Preferred Qualifications:

• Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).
• Experience managing credentialing for multiple providers and facilities.

Why Join HCCS?

• Competitive salary and benefits package.
• Opportunity to work with a collaborative and supportive team.
• Professional growth and development opportunities.