SPE-Provider Credentialing
5 days ago
Job Summary
Join our dynamic team as a Specialist in Provider Credentialing where you will leverage your expertise in healthcare products and credentialing processes to ensure compliance and efficiency. With 4 to 6 years of experience you will play a crucial role in maintaining the integrity of our provider network. This hybrid role offers the flexibility of night shifts allowing you to balance work and personal commitments effectively.
Responsibilities
- Oversee the credentialing and re-credentialing processes for healthcare providers to ensure compliance with industry standards and regulations.
- Collaborate with cross-functional teams to streamline credentialing workflows and improve operational efficiency.
- Analyze provider data to identify discrepancies and implement corrective actions to maintain data accuracy.
- Develop and maintain comprehensive documentation of credentialing procedures and policies.
- Provide support and guidance to providers throughout the credentialing process to ensure a smooth and efficient experience.
- Monitor and report on credentialing metrics to identify trends and areas for improvement.
- Implement best practices in credentialing to enhance the quality and reliability of provider information.
- Coordinate with external agencies and stakeholders to facilitate timely credentialing approvals.
- Utilize healthcare product knowledge to optimize credentialing processes and ensure alignment with organizational goals.
- Conduct regular audits of credentialing files to ensure compliance with internal and external standards.
- Assist in the development and delivery of training programs for new team members on credentialing procedures.
- Participate in continuous improvement initiatives to enhance the overall effectiveness of the credentialing department.
- Ensure all credentialing activities are conducted in accordance with company policies and regulatory requirements.
Qualifications
- Possess a strong understanding of healthcare products and their application in credentialing processes.
- Demonstrate expertise in credentialing and re-credentialing within the healthcare domain.
- Exhibit excellent analytical skills to assess provider data and identify discrepancies.
- Show proficiency in developing and maintaining documentation of credentialing procedures.
- Display strong communication skills to support providers and collaborate with cross-functional teams.
- Have experience in monitoring and reporting on credentialing metrics.
- Be adept at coordinating with external agencies for credentialing approvals.
Certifications Required
Certified Provider Credentialing Specialist (CPCS)
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