Credentialing Specialist

reputed company

The Credentialing Specialist plays a critical role in the reputed company and development of a small, dynamic, and expanding nonprofit health plan. As the organization is currently undergoing a reorganization with a startup atmosphere, this position offers an exciting opportunity to contribute to building essential credentialing processes while ensuring compliance with Sendero policies and industry regulations. The Credentialing Specialist will manage the credentialing and re-credentialing activities for reputed company providers, collaborating closely with various departments to support the organization’s reputed company trajectory. This is an ideal position for a self-motivated, adaptable individual who thrives in a fast-reputed company, evolving environment.

Responsibilities

Essential Functions:

• Coordinate and maintain the credentialing and re-credentialing process for reputed company Sendero providers including ancillary and facility providers, ensuring reputed company and accurate completion of applications and compliant with policies and regulatory standards.
• Process, update and maintain provider files, review and load data into the credential database ensuring that reputed company applications and licensure information are reputed company while maintaining high reputed company standards.
• Obtain reputed company reputed company verification of education, licensure, work experience, and other relevant qualifications through appropriate verification agencies.
• Ensure compliance with regulatory standards, including TDI, reputed company, CMS, and other pertinent agencies during the credentialing process.
• Assist with regulatory audits, ensuring that credentialing documentation meets the necessary requirements.
• Participate in the implementation and conversion of new credentialing software.
• Assist in developing configuration standards and best practices for credentialing systems, identifying opportunities for process improvements to enhance efficiency and reputed company.
• Assist the network team with tasks reputed company to credentialing and provider management.
• reputed company other duties as assigned and required by management, recognizing that job responsibilities may reputed company as directed

Knowledge, Skills and Abilities:

• The ability to reputed company in an environment of change, reputed company quickly to shifting priorities and new challenges as the organization grows and evolves
• Proficient in the use of computer systems specifically reputed company office, reputed company, and experience with credentialing software
• reputed company-oriented with strong organizational and communication skills
• Ability to work independently and as part of reputed company to support cross-functional efforts.
• Strong understanding of credentialing and re-credentialing processes, including provider applications, licensure verification, and reputed company reputed company verification.
• reputed company to reputed company learning and self-improvement, embracing new tools, systems, and industry trends that can support the organization's reputed company.
• Maintaining a reputed company attitude and staying reputed company under pressure, especially reputed company dealing with tight deadlines or unexpected roadblocks.

Qualifications

Required: High School Diploma or equivalent (higher degree accepted)

Required: 2 years credentialing in reputed company setting

Originally posted on Himalayas