Credential Specialist

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Our client provides a range of health solutions for rural communities. With new projects on the horizon, they are hiring a Credential Specialist to be responsible for inventory, provider inquiries, provider experience, and to ensure accuracy of provider data in order to uphold exceptional provider networks.

This Role Offers:

Competitive base salary plus comprehensive benefits, including medical/dental/vision, 401(K), and more. Stable company with over seven decades of experience. Tight-knit culture focused on taking care of their employees. Ample opportunities for growth and career advancement. High employee tenure with low red tape culture. They hire professionals and trust their expertise, giving them room to make tangible impacts.

Focus:

Research and evaluate provider status and information completeness by using inventory systems. Contact providers to clarify any missing or incorrect data by reviewing aging reports. Provide insight to enhance processes by identifying gaps in provider information. Respond to inquiries regarding provider updates and questions in a timely manner. Prepare reports for leadership and committees by analyzing credentialing data. Investigate accreditations, license status, and board certifications. Assist with sensitive issues that pertain to credentialing facilities and providers. Collect updated provider rosters to ensure accuracy. Ensure compliance with delegation monitoring. Collaborate with team members effectively. Complete additional tasks assigned as needed. Conduct professional communication with relevant parties to acquire necessary information.

Skill Set:

1+ years of experience in healthcare field required, including prior experience in provider relations/contracts/credentials. Bachelor’s Degree or relevant experience in healthcare credentialing required. Knowledge of CAQH is a strong plus. Prior experience with Medicare Advantage preferred. Robust organizational skills and ability to manage data collection/credentialing functions. Strong written, verbal, and presentation skills, with ability to develop internal and external relationships. Ability to thrive in a fast-paced work environment and able to prioritize tasks accordingly.