Job Description

Job Description

Job Description

Become a Medical Credentialing Champion!

Are you detail-oriented and passionate about ensuring quality in healthcare? As a Credentialing Specialist, you'll play a vital role in verifying provider qualifications, maintaining compliance, and supporting a high standard of care.Join our team and help us build a network of top-tier healthcare professionals! You'll review provider documentation, manage the credentialing process, support audits, and collaborate with providers to ensure a seamless experience.

REQUIREMENTS: • Work experience and knowledge of NCQA guidelines• High-level interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams across department lines, management levels, and business entities.• High degree of emotional intelligence and self-management ability. Able to remain calm, focused, and productive in stressful situations, conflicts.• Excellent organizational, planning and time management skills.• strong attention to detail skills• Excellent analytical and problem-solving skills• Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff.• Ability to communicate with individual staff and teams of all levels• Proficient in Microsoft Office Outlook, Word, Excel, and Power Point• Ability to work in a matrix-management environment to achieve organizational goals• Excellent reasoning, problem solving, prioritization and business judgement.• Working knowledge of typical health plan or Medical Staff Credentialing operations.KNOWLEDGE AND SKILLS PREFERRED:• Proficient in Microsoft office, Word, Excel, PowerPointEDUCATION AND EXPERIENCE REQUIRED: • Associates degree or 3 years of experience in the field of health insurance (HMO, health insurer, TPA, broker, Quality Assurance, physician practice or healthcare setting) sufficient to yield the knowledge requirements.• Minimum of five years of professional secretarial, administrative, credentialing, provider network, medical staff facility or provider facility experience.

If you're ready to make a difference in healthcare quality, apply now!FOR MORE IMMEDIATE CONSIDERATION, email a current resume to [email protected]: Your NAME and CREDENTIAL to 954-308-6735

salary: $20 - $30 per hour
shift: First
work hours: 9 AM - 5 PM
education: High School

Responsibilities

The Credentialing Specialist is responsible for activities associated with credentialing or re-credentialing of network providers, including review of providers credentialing documentation, processing, loading providers into the tracking database system to ensure high quality standard are maintained. Credentialing Specialists will assist with audits, provide feedback to reduce errors and improve processes and performance. Works with the Provider Representatives and provider practices to gather documentation required for the Initial and Re-credentialing process. Acts as support to the CVO for the PHSO teams.

• Collects/evaluates initial/re-credentialing applications.
• Supports NCQA audits, ensures QA compliance.
• Evaluates provider documentation for re-credentialing.
• Monitors credentialing cycle for compliance.
• Communicates credentialing status to providers.
• Follows up on non-compliant providers, recommends action.
• Prepares monthly credentialing outcome reports.
• Assists with mailing applications/follow -ups.
• Answers calls, prepares mail-outs, assists with projects.
• Maintains/files provider files (manual/electronic).
• Sets up files, scans/uploads documents.
• Prepares provider grids/profiles for committee review.
• Supports meeting coordination, manages deadlines/agendas.
• Assists with meeting minutes/follow-up items.
• Assists with post-meeting activities (notifications, letters)

Skills

• NCQA Guidelines (4 years of experience is required)
• credentialing (1 year of experience is required)
• NCQA audit processes
• credentialing QA standards
• health insurance (3 years of experience is required)
• Managed Care Credentialing (1 year of experience is required)
• Delegated Credentialing (2 years of experience is required)

Qualifications
• Years of experience: 5 years
• Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected].
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Job Tags

Hourly pay, Permanent employment, Temporary work, Work experience placement, Immediate start, Shift work,

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