Credentialing Specialist

Position Summary

The Credentialing Specialist is responsible for completing and auditing healthcare providers credentialing files, complying with policies and procedures.

Duties and Responsibilities

• Identify errors in credentialing files reported as completed, previous determinations.
• Identify gaps between credentialing and recredentialing files.
• Identify questionable data in system audit trails.
• Providers clarifications.
• Primary source verifications.
• Identify errors, omissions or incongruencies.

Education, experience, and knowledge:

• Academic degree in Office Systems, Administrative Assistant, Medical Billing, or others related, from an accredited institution.
• At least, two years in credentialing position.
• MS Office applications and internet use.
• QNXT, PMHS, Portico, EZCap, Cactus, Symplr or other healthcare credentialing platform experience.

Skills and abilities: 

• Problem solving.
• Oriented to constant analysis, focusing on details.
• Results and quality oriented.
• Confidentiality oriented
• Time management
• Highly organized.
• Policies, procedures and regulations understanding.
• Reading and interpretation of documentation in english and spanish languages.

Physical Demands

While performing the duties of this job, the employee is required to sit most of the time, use hands, fingers, verbal communications and have vision abilities, including focus.

Position Type/ Expected Hours of Work

This is a full-time position.  Monday through Friday, general time span: 8:00 a.m. to 6:00 p.m.  Occasionally, out of work time span may be required, as job duties demand.

Work Environment

This job operates in a clerical office setting and/or remote setting.  This role routinely uses standard office equipment such as computers, phones, mouse, keyboard, etc.

The work environment characteristics described here are representative of those encountered while performing the essential functions of this job.  Support tasks, tied to knowledge, can be included.