Credentialing Specialist
2 weeks ago
Key Responsibilities:
Credential Verification:
Conduct primary source verification of education, licenses, certifications, and work history.
Perform background checks including criminal records and disciplinary actions.
Compliance & Regulation:
Ensure compliance with NCQA, CMS, The Joint Commission, and other regulatory bodies.
Monitor expiration dates and initiate timely renewals of credentials.
Documentation & Database Management:
Maintain accurate records in credentialing software (e.g., CAQH, PECOS, NPPES).
Track and update provider profiles and credentialing logs.
Communication & Coordination:
Liaise with providers, payers, and internal departments to resolve discrepancies.
Respond to inquiries and facilitate credentialing-related communication.
Audit & Reporting:
Prepare for internal and external audits.
- Generate reports on credentialing status and compliance metrics.
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