Job description

Responsibilities:

• Collaborate with the team and management to identify credentialing needs and requirements.
• Collect, review, and verify all relevant documents and credentials including licenses, certifications, and education.
• Maintain accurate and up-to-date credentialing records and databases.
• Conduct thorough background checks, including reference checks, to verify the professional history and integrity of healthcare providers.
• Ensure compliance with all relevant accreditation and regulatory standards, including NCQA, CMS, and state-specific requirements.
• Manage the recredentialing process and regularly assess the ongoing competence of healthcare providers.
• Collaborate with external organizations and insurance providers to ensure seamless reimbursement and compliance.
• Keep abreast of changes in industry regulations and standards, and adjust credentialing processes accordingly.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field. Master’s degree preferred.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification preferred.
• Minimum of 3 years of experience in credentialing within a healthcare setting.
• In-depth knowledge of healthcare accreditation and regulatory requirements (e.g., NCQA, CMS, Joint Commission).
• Strong analytical and organizational skills, with meticulous attention to detail.
• Excellent communication and interpersonal skills.
• Proficiency in credentialing software and database management.

Job Type:

• Full-time