Credentialing Specialist

Job Description

Job Description

We are looking for a dedicated Credentialing Specialist to support healthcare operations in Richmond, Virginia. This long-term contract position offers the opportunity to apply your expertise in credentialing processes and compliance within the managed care sector. Join a dynamic team where your skills will ensure smooth workflows and adherence to industry standards.

Responsibilities :

• Oversee credentialing and re-credentialing applications for healthcare providers, ensuring compliance with Medicare, Medicare Advantage, and managed care organization standards.
• Manage the end-to-end credentialing process, including verifying provider qualifications, certifications, and licensure.
• Maintain accurate and up-to-date records in credentialing databases and systems.
• Ensure compliance with regulatory requirements and industry standards throughout credentialing workflows.
• Collaborate with healthcare providers and internal teams to address credentialing inquiries and resolve issues promptly.
• Conduct thorough audits of credentialing applications and documentation to ensure accuracy and completeness.
• Stay informed on changes in healthcare regulations and credentialing requirements to adapt processes as needed.
• Provide training and guidance to team members on credentialing procedures and best practices.
• Support the implementation of process improvements to enhance efficiency and accuracy in credentialing operations.
• Minimum of 3 years of experience in credentialing within managed care organizations.
• Expertise in Medicare and Medicare Advantage credentialing protocols and compliance requirements.
• Proficiency in handling provider credentialing and re-credentialing applications.
• Strong understanding of credentialing processes and healthcare industry regulations.
• Exceptional organizational and administrative skills, with attention to detail and accuracy.
• Ability to work independently and manage credentialing workflows effectively.
• Familiarity with credentialing software and databases.
• Strong communication skills to liaise with healthcare providers and internal teams.