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Why You'll Love This Job
The Medical Staff Credentialing Specialist at OFFOR Health is responsible for managing and executing credentialing and recredentialing applications for healthcare providers. This role is vital in ensuring compliance with regulatory standards, maintaining accurate provider databases, and supporting the provider onboarding process. The specialist will collaborate closely with internal departments and external health plans to ensure timely credentialing, contributing to operational efficiency and regulatory adherence.
Responsibilities
To perform successfully in this position, an individual must be able to execute each key responsibility effectively. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned to meet business needs.
- Complete and submit initial and recredentialing applications for healthcare providers in alignment with payor guidelines, accreditation standards, and government regulations.
- Load and update provider information in credentialing databases, including CAQH, NPPES, and other relevant platforms, maintaining accuracy and completeness.
- Track license and certification expiration dates, proactively coordinating renewals to avoid lapses.
- Conduct routine audits of health plan directories to confirm accuracy and up-to-date provider information.
- Communicate and collaborate proactively with health plans to facilitate provider enrollment and reduce claims risk.
- Coordinate documentation management for licenses, DEA certificates, board certifications, and other essential credentials.
- Collaborate with internal teams such as Administration, Legal, and Revenue Cycle to ensure streamlined provider credentialing and compliance processes.
- Notify relevant departments of enrollment statuses to facilitate operational readiness and billing processes.
- Address issues related to provider network participation and collaborate to resolve payment denial issues efficiently.
- Research and update team members on health plan enrollment policy changes and ensure compliance with the latest standards.
- Operate independently, managing multiple priorities, deadlines, and escalations as needed.
Skills & Qualifications
Education and Experience Requirements
Knowledge, Skills and Abilities
Network Requirements
High-speed internet with a minimum download speed of 25 Mbps and a minimum upload speed of 5 Mbps
OFFOR Health Benefits
OFFOR Health currently offers full competitive employee benefits including medical, dental and vision insurance, LTD, STD and Group Life insurance, 401(k) retirement plan, flexible time off and paid holidays.
OFFOR Health does not discriminate on the basis of actual or perceived race, religion, color, national origin, ancestry, disability, medical condition, marital status, sex, age, sexual orientation, gender identity or expression, family responsibility, personal appearance, genetic information, matriculation, political affiliation, or any other status protected under law.
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- High School Diploma or GED required; an associate or bachelor’s degree in a related field is preferred.
- 1-2 years of credentialing experience is preferred, with familiarity in credentialing software and accreditation standards (e.g., NCQA, AAAHC, JCAHO) considered a plus.
Knowledge, Skills and Abilities
- Proficient in Microsoft Office and credentialing-specific software.
- Strong organizational skills with high attention to detail and accuracy.
- Ability to work effectively in a fast-paced environment, managing multiple tasks and deadlines independently.
- Excellent communication and interpersonal skills to liaise with health plans and internal teams effectively.
- Strong analytical and critical thinking skills, with the ability to identify and resolve credentialing issues.
- Commitment to maintaining confidentiality and a strong collaborative mindset.
Network Requirements
High-speed internet with a minimum download speed of 25 Mbps and a minimum upload speed of 5 Mbps
OFFOR Health Benefits
OFFOR Health currently offers full competitive employee benefits including medical, dental and vision insurance, LTD, STD and Group Life insurance, 401(k) retirement plan, flexible time off and paid holidays.
OFFOR Health does not discriminate on the basis of actual or perceived race, religion, color, national origin, ancestry, disability, medical condition, marital status, sex, age, sexual orientation, gender identity or expression, family responsibility, personal appearance, genetic information, matriculation, political affiliation, or any other status protected under law.