[Hiring] Credentialing Specialist @Central Health

Role Description

The Credentialing Specialist plays a critical role in the growth and development of a small, dynamic, and expanding nonprofit health plan. This position offers an exciting opportunity to contribute to building essential credentialing processes while ensuring compliance with Sendero policies and industry regulations.

• Manage the credentialing and re-credentialing activities for all providers.
• Coordinate and maintain the credentialing and re-credentialing process for all Sendero providers including ancillary and facility providers.
• Ensure timely and accurate completion of applications compliant with policies and regulatory standards.
• Process, update, and maintain provider files, reviewing and loading data into the credential database.
• Obtain primary source verification of education, licensure, work experience, and other relevant qualifications.
• Ensure compliance with regulatory standards, including TDI, NCQA, CMS, and other pertinent agencies.
• Assist with regulatory audits, ensuring that credentialing documentation meets necessary requirements.
• Participate in the implementation and conversion of new credentialing software.
• Assist in developing configuration standards and best practices for credentialing systems.
• Identify opportunities for process improvements to enhance efficiency and quality.
• Assist the network team with tasks related to credentialing and provider management.
• Perform other duties as assigned and required by management.

Qualifications

• High School Diploma or equivalent (higher degree accepted).
• 2 years credentialing in a healthcare setting.

Requirements

• The ability to thrive in an environment of change and adjust quickly to shifting priorities and new challenges.
• Proficient in the use of computer systems specifically Microsoft Office, Adobe, and experience with credentialing software.
• Detail-oriented with strong organizational and communication skills.
• Ability to work independently and as part of a team to support cross-functional efforts.
• Strong understanding of credentialing and re-credentialing processes, including provider applications, licensure verification, and primary source verification.
• Open to continuous learning and self-improvement, embracing new tools, systems, and industry trends.
• Maintaining a positive attitude and staying focused under pressure, especially when dealing with tight deadlines or unexpected roadblocks.