The Credentialing Specialist will oversee all facets of the provider credentialing process. The Specialist is responsible for provider rate amendments; terminations; address changes; ad hoc reporting; and data entry. Ensure provider compliance with credentialing standards. Answer customer/provider calls effectively and provide exemplary customer service. Establish and maintain good working relationships with providers and ensure the completeness of data. Receive detailed instruction on all work. Perform contract review to determine any discrepancies. Complete special assignments as requested.
• Coordinate provider credentialing process to increase efficiency and ensure that credentialing deadlines are met.
• Collection of primary source information and data entry related to provider network participation.
• Log and prepare credentialing applications for committee review. Review provider credentialing files to ensure that facilities are in compliance with current standards.
• Meet department credentialing and accuracy quotas.
• Process provider amendments timely to ensure that deadlines are met.
• Facilitate the receipt and review of completed provider data updates and amendments while ensuring that facilities are in compliance with current standards.
• Assist with collecting and collating files for payer audits.
• Work with team members on new processes and state requirements.
• Support department with any new customer initiatives.
• Answer, research, resolve and document provider calls involving a wide range of issues utilizing multiple information systems (with support).
• Assign appropriate provider service database ratings to existing and new providers.
• Maintain teamwork, customer service production and quality standards to assure timely, efficient and accurate process resolution.
• Work on special projects as assigned.
Bachelor Degree in Health, Business or the equivalent is preferred, but not required. Minimum one year credentialing experience, preferably in the managed care industry preferred, but not required. Knowledge of NCQA and URAC standards preferred, but not required.
• Candidate will possess excellent communication (oral and written), organizational and interpersonal skills.
• Must have attentive listening skills and maintain a professional demeanor.
• Critical thinking.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.