Job Description

Duties

• The Credentialing Specialist is responsible for processing and completing the credentialing and re-credentialing functions of all providers by NCQA, state, and federal requirements.

Principal Accountabilities:

• Validates completeness of provider applications before processing.
• Conducts primary source verification for all credentialing and re-credentialing applications.
• Monitors the progress and completion of all site visits by the provider network team to ensure completion within the established timeframe.
• Accurately enters all critical data elements of provider applications into the Credentialing system.
• Respond to phone inquiries received in the Credentialing phone queue from internal and external clients.
• Completes projects as assigned.

Skills:

• Intermediate knowledge of PC applications, including Microsoft Office.
• Strong verbal and written communication skills.
• Strong organizational skills are required.
• Ability to perform in a metrics-driven environment..

Education

• Associates Degree
• Bachelor's Degree

Job Tags

Similar Jobs