Credentialing Specialist

Description:

organization. The successful candidate will be responsible for ensuring that our network of healthcare providers meets all regulatory and compliance requirements, as well as maintaining relationships with insurance carriers and managing the credentialing team.

Responsibilities:

· Develop and implement credentialing policies and procedures to ensure compliance with industry standards and regulations.

· Oversee the credentialing process for healthcare providers, including initial credentialing, re-credentialing, and privileging.

· Maintain relationships with insurance carriers and negotiate contracts and reimbursement rates.

· Monitor and track credentialing activities to ensure timely completion and accuracy of credentialing files.

· Provide leadership and guidance to the credentialing team, including training and development opportunities.

· Stay abreast of changes in healthcare regulations and industry standards related to credentialing and make recommendations for process improvements.

· Collaborate with other departments, such as provider relations and network management, to ensure seamless integration of credentialing processes.

Qualifications:

· Bachelor's degree in healthcare administration, business administration, or related field; Master's degree preferred.

· Minimum of 2 years of experience in healthcare credentialing.

· In-depth knowledge of credentialing processes, regulations, and accreditation standards.

· Strong analytical and problem-solving skills with attention to detail.

· Excellent communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders.

· Proficiency in Microsoft Office Suite and credentialing software.