Job Summary

The Credentialing Specialist plays a crucial role in ensuring that healthcare providers meet all necessary qualifications and comply with institutional state and federal regulations. This position involves verifying the education, training, certifications, and work history of healthcare professionals to ensure compliance with organizational policies and legal requirements

Responsibilities

Perform primary source verification and support payer enrollment of healthcare providers credentials, including education board certifications work experience and licensure.
Maintain and update provider information in credentialing databases and files ensuring that all data is current and accurate.
Submit and process applications for provider credentialing and re credentialing with healthcare organizations insurance payers and regulatory bodies.
Ensure that all credentialing and re credentialing documentation meets compliance standards including state and federal regulations.
Monitor and track license and certification expirations alerting providers and management to any renewals or required updates.
Communicate with providers internal departments and external agencies to resolve discrepancies or obtain missing documentation. Insure timely and accurate completion of credentialing processes to meet deadlines.
Assist in audits ensuring all credentialing files are complete and up to date.
Adhere to all organizational policies procedures and compliance guidelines.
Oversee accreditation for pay your enrollment and primary source verification.
Strong knowledge of healthcare credentialing requirements and regularizations regulations.
Proficiency in credentialing software and databases.
Exceptional attention to detail and organizational skills.
Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
Strong written and verbal communication skills.
Skills and competencies:
analytical and problem-solving skills.
ability to maintain confidentiality and manage sensitive information with discretion.
strong interpersonal skills with the ability to work effectively with a diverse group of people.
excellent time management and ability to prioritize tasks.

EDUCATION:
High school diploma or GED required, Associate or Bachelor’s degree preferred.

Certification and credentialing CPCS or CPMSM from NAMSS is highly desirable. Two plus years of experience and credentialing or related field preferably within healthcare.

Knowledge, Skills & Abilities

Education 

• High School Diploma or GED (Required)
• Associate's DegreePreferred

Credentials 

Work Schedule: Days

Status:  Full Time Regular 1.0

Location: Northgate-400 Association Dr.

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Tamara B. Young tammy.young@vandaliahealth.org