Job Description

Job Description

Job Description

Seeking an experienced Healthcare Credential Specialist to work on a temp-to-perm basis in Philadelphia, PA! In this role you will manage all aspects of the credentialing, payer enrollment and privileging, assist with onboarding of new providers, maintain compliance with documentation standards and requirements. All qualified applicants are encouraged to apply!

• Ensure accurate and timely credentialing, re-credentialing and enrollment.
• Produce applicable credentialing, enrollment and privileging reports.
• Present verification findings to the Credentialing Committee.
• Verify provider credentials.
• Track and maintain confidential personnel files and copies of current credentialing documentation.
• Ensure completion of clinician applications for payers
• Maintain compliance with credentialing documentation standards for licenses, certifications, registrations, permits, educational degrees, association memberships.
• Track and maintain Medicare exclusion checks for all employees.
• Update CAQH database with quarterly attestation
• Demonstrate knowledge of the Health Resources and Services Administration (HRSA), Federal Tort Claims Act (FTCA), NCQA standards, federal and state regulations, NPDB guidelines and general licensing regulations and other applicable regulations.
• Verify credentials meet federal, state, and FPCSN requirements.
• 
  Required Qualifications:
• Bachelor Degree and minimum 2 years of experience OR Associates Degree and minimum 4 years of experience.
• Degree Business, Healthcare Administration or Health Information Management.
• Proficiency in Microsoft Office Suites and proprietary database applications.
• Knowledge of provider credentialing criteria and processes in accordance with NCQA standards, NPDB guidelines and general licensing regulations.
• Familiarity with community health centers with medical, dental and/or behavior health practices.
• 
  Preferred Qualifications:
• Certification by the National Association of Medical Staff Services (NAMSS) and minimum 3 years of experience (in lieu of the degree).
• Certified Professional Credentialing Specialist (CPCS).
• Certified Provider Credentialing Specialist (CPCS). 
• Certified Medical Staff Coordinator (CMCS). 
• 
  Note: Qualified candidates will be contacted within 2 business days of application. If an applicant does not meet the above criteria, we will keep your resume on file for future opportunities and may contact you for further discussion.
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