Credentialing Specialist II (Remote Opportunity!)

Position Overview

The Credentialing Specialist II performs the credentialing and re-credentialing of provider applications in accordance with the departmental policies and procedures and in compliance with applicable State and Federal laws and regulations, as well as National Committee for Quality Assurance (NCQA) standards.

Primary Duties and Responsibilities

Receives and processes incoming applications and supporting credentials from providers

Performs timely follow-up with providers on all pending applications

Performs the primary source verification according to departmental policies and NCQA standards

Builds and accurately maintains provider information in various systems

Responds to inquiries regarding the status of provider’s application

Qualifications

Knowledge, Skills and Abilities

1-3 years credentialing experience, preferably in a managed care setting, preferred

Associate degree or Certified Provider Credentialing Specialist (CPCS) certified preferred

Knowledge of NCQA standards and payer credentialing standards highly desired

Previous experience working with Council for Affordable Quality Healthcare (CAQH) application highly desired

Knowledge of dental industry preferred

Strong computer, data entry and clerical skills required

Excellent interpersonal, oral and written communication skills required

Critical thinking, detail oriented and strong organizational skills required

Leadership Behaviors

Continuously strives to provide superior products and customer service

Builds collaborative relationships that are mutually respectful

Demonstrates self-awareness and embraces feedback

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Prosjekt-ID: #18924682

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