Credentialing Specialist

» Credentialing Specialist
Finance & Accounting
in Richmond
, VA
Reference: 19-01807

Key Duties and Responsibilities :

  • Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing
  • Perform all required primary source verifications
  • Contact hospitals, licensing agencies, malpractice carriers and medical schools to obtain credentialing verifications
  • Maintain and update credentialing database records
  • Review malpractice history. regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures
  • Review the CAQH system and download applications or supplemental documents as appropriate
  • Maintain electronic provider files
  • Perform outreach to providers and facilities via phone calls and fax/email correspondence
  • Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA. CMS. Medicaid. etc.)

Qualifications:

  • 1+ year of healthcare experience HIGHLY PREFERRED
  • 2+ years of experience in a customer service or healthcare related position required
  • Must have skills with Internet browser and high volume data entry
  • Production environment
  • General PC skills
  • Information gathering and researching
  • Ability to work overtime