Find below a sample job description template for the position of Credentialing Specialist:
Job Title: Credentialing Specialist
Location of the Job: Sacramento, CA 95825
Years of Experience: 2 to 3 Years
Job Type: Full Time Employee
Education Level: Bachelor’s degree
The Network Management Credentialing Specialist is responsible for performing credentialing activities in support of network recruitment activities.
Duties and Responsibilities:
- Maintains required logs and prepare reports, as needed.
- Produce provider correspondence as necessary to process the applications.
- Answer inquiries regarding provider credentialing status.
- Maintains knowledge of CMS and NCQA credentialing guidelines.
- Perform monthly internal audits on credentialing and re-credentialing files for accuracy and compliance with Credentialing Policies and Procedures
- Provide credentialing staff mentoring.
- Keep Manager informed of concerns or problems with credentialing processes.
- Assists market in any pre-delegation audits and the annual on providers delegated for the credentialing process.
- Prepare presentations for credentialing committee meetings including meeting agendas and minutes.
- Summarize provider information for peer review by the Credentialing committee.
- Identify and analyze non-routine provider records.
- Confirm all required verifications are complete and have been performed according to required standards and within required timeframes.
- Accurate data entry of credentialing information into the database.
- Other duties as assigned.
- Opportunity for growth
- Excellent work environment
- Competitive salary and benefit package
- Excellent communication skills
- 2+ years of related experience
Salary: $15.00 – $20.00 Hourly DOE