Credentialing SpecialistHealthcare's helping hand. CHG shook things up in 1979 by inventing the locum tenens staffing model. We connect doctors with patients who need their care. As the largest physician staffing firm in America, our providers treat millions of patients each year.
Our industry is growing and demand is high. This means you'll have plenty of opportunities to grow and develop in your career. Keeping healthcare healthy can be as fun as it is rewarding.The Credentialing Specialist is responsible for credentialing and recredentialing client practitioners as well as ensuring enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing credentialing applications, performing primary source verifications and updating and maintaining credentialing database in accordance with internal policies and procedures, client health plan contracts and applicable state and federal requirements.This is a temporary position, expected to last no more than one year.ResponsibilitiesInitiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for payor enrollment and credentials verification processResponsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s)Enroll providers with client payors to include Medicare, Medicaid and state and federal commercial health plans and follow up as required until process completeUpdate CAQH and NPI information consistent with client practice informationResponsible for gathering, verifying evaluating highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standardsRespond to all practitioner, client health plan and internal inquiries in a timely mannerMonitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed timeframeMaintain practitioner paper and electronic data files for clients; utilizing CAQH to submit practitioner data as required to credential individual practitionersCollaborate with participating clients in a professional manner, department manager and/or external agencies to facilitate and ensure smooth hand-off during the credentialing processFollow up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing processPerform all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner filesConduct sanctions and compliance monitoring and alert Manager of any undisclosed negative findings immediatelyParticipate in team meetings and process improvement initiatives to continuously improve work product quality and efficiencyContributes to positive cultureKeep Manager informed of potential credentialing or enrollment issuesQualificationsProficient using payor websites including but not limited to CAQH, Pecos, NPI/NPPES, Availity, NaviNet, CMS I&AProficiency ins using various software used for provider applications, verifying credentials and tracking verification statusesProficient with payor enrollment process for all levels of licensure including but not limited to MD/DO, NP, PhD, PT, OT, LCSW, OD, DDS, DPM, etc.
across all specialties including medical, dental, vision, behavioral health and physical healthKnowledge of primary source verification--understand the process of verifying information directly from the original/authorized source that meets relevant regulations, accreditation requirements and compliance standardsExperience should include 3-5 years of responsibility for medical credentialing processes, policies and procedures and delegated credentialing requirementsAble to communicate clearly and concisely, both verbally and in written correspondenceAble to work well under tight deadlines and respond to rapidly changing demands and provide efficient follow upDetail oriented with ability to recognize vital information from credentialing documentsDemonstrate problem-solving, critical thinking, and deductive reasoning skillsAbility to consistently maintain quality and production expectationsAbility to learn and use credentialing database and other related databasesCapable and comfortable dealing with sensitive and confidential information with discretion and trustProficiency with MS Office suiteEducation & ExperienceAssociate's degree; or, an equivalent combination of education and/or experienceMinimum of 3 years' experience in provider credentialing in a healthcare settingCertified Provider Credentialing Specialist (CPCS) preferredProvider Enrollment Specialist Certificate (PESC) preferredWe believe in fair compensation for all of our people, which is why our pay structure takes into account the cost of labor across U.S. geographic markets. For this position, we offer a pay of $25.00/hour.In return, we offer:• Competitive pay• Flexible work schedules - including work from home options available• Award-winning training and development programsCHG Healthcare values a diverse and inclusive workforce. Interested in this role but not a perfect fit?
Apply anyway.We welcome applicants of any race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status and individuals with disabilities as an Affirmative Action/Equal Opportunity Employer. We are an at-will employer.What makes CHG Different? You.