Job Description

Job Description

Credentialing Specialist

Join our team of dedicated professionals and play a critical role in ensuring the smooth operation of our credentialing and recredentialing processes. As a Business Analyst, you will be responsible for processing practitioner and organization/facility provider applications, verifying information, and updating records in our system of record. If you have a passion for detail, excellent communication skills, and experience in provider enrollment or credentialing, we want to hear from you.

Key Responsibilities:

• Process practitioner and organization/facility provider applications for credentialing and recredentialing
• Verify primary source documentation and evaluate case categorization
• Provide credentialing status information to various stakeholders
• Assist with special projects and job aids as needed
• Attend Credentials Committee meetings and participate in auditing processes

Required Skills and Experience:

• 2-5 years of work experience in provider enrollment, contracting, medical practice, or hospital business office role and/or credentialing related field
• Knowledge of related state/federal regulations, NCQA, DIFS, MDHHS, and CMS standards for credentialing
• CAQH knowledge required
• Excellent organizational skills with attention to detail
• Excellent verbal and written communication skills
• Ability to handle and prioritize multiple case files and timelines
• Ability to work effectively independently or in a team environment
• Intermediate knowledge of Microsoft Word, Excel, Access, PowerPoint, and internet use

Nice to Have Skills:

• Excellent interpersonal skills and the ability to interact with internal/external customers
• Experience with auditing processes and internal meetings

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