Job Summary
A healthcare services and support organization is filling a position for a Remote Senior Credentialing Specialist.
Must be able to:
- Maintain up to date data for each provider in databases
- Perform quality review audits of credentialing files
- Present files to Medical Director or Credentialing Committee as required
Skills and Requirements Include:
- Knowledge of NCQA and CMS regulatory requirements
- 5+ years of experience in managed care credentialing, provider enrollment and/or Medical Staff service setting
- Experience managing CAQH Provider Profiles
- Must comply with HIPAA rules and regulations
- Working knowledge ofpayer credentialing rules and regulations
- Demonstrated skills in problem solving, analysis and resolution
