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Description:

Summary: The Credentialing Specialist is responsible for credentialing individual facility and/or ancillary medical/surgical providers to ensure all credentialing standards and internal requirements are met and maintained.

Job Responsibilities:

• Verifies and maintains all network individual and/or facility/ancillary providers information. Monitors disciplinary actions and follows up accordingly.

• Corresponds with licensing board hospitals certification agencies training programs and medical groups to resolve any issues.

• Ensures and maintains overall accuracy of credentialing database. Gathers data builds/runs reports and sends out updates.

• Corresponds with licensing board hospitals certification agencies training programs and medical groups practitioners office staff provider network administrators contracting and management to resolve issues.

• May review and identify credentialing or re-credentialing practitioners including verifications of correspondence data entry etc. in accordance with company policies and procedures. Reviews and analyzes reports policies and procedures summarizes analyzes and makes notations in reports for feedback to groups and for distribution to management and Credentialing Committee.

• Assists in the preparation of file reports and binders for monthly Credentialing Committee meetings including pre-and post-Committee functions.

• Needs to have knowledge about NCQA and CAQH guidelines.

• Assists on internal projects to obtain follow-up information as requested by Credentialing Committee or Peer Review Teams. Performs other duties as assigned.

Skills:

Medical customer service, Medical terminology, CAQH, NCQA, Cactus, Providers Data Management.

Top Skills Details:

Medical customer service

Additional Skills & Qualifications:

Education/Experience: High school diploma. Associates degree in Business Administration Health Care Administration or related field preferred.0-2 years of experience

Experience Level:

Entry Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.