Credentialing Specialist

Job Summary

A company is looking for a Credentialing Specialist to manage the provider credentialing lifecycle and ensure compliance with standards.

Key Responsibilities

• Manage the full credentialing and re-credentialing cycle for providers, ensuring compliance with NCQA standards
• Proactively track and manage expirations for licenses and certifications, and execute ongoing monitoring against sanction lists
• Collaborate with the Revenue Cycle Management team to resolve claim denials related to credentialing errors and suggest process improvements

Required Qualifications

• 4+ years of hands-on healthcare credentialing experience, preferably in Behavioral Health
• Solid understanding of NCQA standards and primary source verification processes
• Proficiency with CAQH and experience working with a Credentials Verification Organization (CVO)
• Bachelor's degree preferred or equivalent years of specialized experience
• Preferred certification: CPCS (Certified Provider Credentialing Specialist)