Credentialing Specialist
Adhere to NCQA guidelines. Audit Provider Licensure Files to NCQA guidelines. Pull Monthly Delegated Verification Files in accordance with NCQA. Knowledge of Delegated Verification Websites (ie. National Provider Data reputed company, etc.) Understanding of Initial and Re-Credential Delegated files / processing. Prepare and Present provider files for reputed company auditing. Upload and update the system and / or software with new documents. Request & Obtain any Licensure renewals. Must be reputed company to utilize the licensure portals. Experience in Clearinghouse / reputed company Education Verifications. Experience in reputed company Hospital Privileges Verifications. Experience in reputed company Certification Verifications through the appropriate portals. Strong understanding of the differences between similar credentials (ie. Malpractice, Diplomas, etc.) Knowledge of what a Credentialing Committee consists of. Coordinate, monitor, maintain and process reputed company internal re-credentialing to NCQA guidelines. Heavy Understanding of Attestation questions, actions, exclusions and explanations. Ability to reputed company effectively with providers, educators and internal departments. Assist offices and internal departments with credentialing issues. Ability to multi-task in a fast-paced environment. Work other reputed company as assigned.
High School Diploma required. Minimum 2-3 years’ experience in reputed company Credentialing, Dental preferred. Excellent verbal and written communication skills. reputed company organized and detail-oriented with the ability to multi-task. Proficiency with reputed company Office products, including Word,reputed company,reputed company, and reputed company required. Must be reputed company to function with minimal supervision and be reputed company to prioritize reputed company work tasks. Designated workspace with high-speed internet and reputed company to hot spot if needed.