Medical Credentialing Specialist

Job Description

Job Description

Job Purpose

JVM Solutions is hiring a Medical Credentialing Specialist to support a Processing Center in El Paso, TX.

Duties and Responsibilities

• Coordinate and communicate activities with the Credentialing Office supervisor or designee.
• Manage the credentialing process for healthcare providers and other licensed professionals through the process and units.
• Audit files for completed information upon submission and communicate with providers to address any discrepancies or missing information.
• Monitor expiring licenses and credentials, proactively initiating the renewal process to avoid any disruption in services.
• Verify the accuracy and completeness of healthcare provider applications, ensuring that all required documents are submitted.
• Maintain liaison and coordinate with internal and external agencies to obtain and update relevant provider information.
• Perform primary and secondary source verifications of credentials according to departmental policy.
• Establish and update practitioner's credentials files (PCF) and provider activity files (PAF) on providers going through the screening process.
• Notify Network Services Representatives and Credentialing Office supervisor within 72 hours of being unable to obtain required documentation or non-responsiveness.
• Prepare files for presentation to the Chief Medical Officer and Credentialing Committee.

Qualifications

Other Requirements

Johnson Venture Management Solutions, Inc. is an equal opportunity and affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.