Credentialing Specialist Physician Healthcare

Job Family :

Patient Account Representative Credentials

Travel Required : None

Clearance Required : None

What You Will Do :

The Credentialing Specialist is responsible for coordinating processing monitoring and maintaining the initial and reappointment confidential credentialing process for designated providers. Ensures timeliness and compliance with client standards and compliance as well as all legal and regulatory requirements. The Credentialing Specialist is responsible for accuracy and integrity of the credentialing database system either client owned or Guidehouse credentialing system.

Monitor and ensure compliance with company and client standards

Strong understanding of credentialing software software / systems used

Gather verify and evaluate healthcare provider credentials for initial and recredentialing applications; identify potential issues; determine if further investigation or information is necessary and make appropriate inquiries; assess completed applications

Responsible for ensuring timely enrollment of new providers with 3rd party and government payers; and maintenance of existing active physicians and advanced practice providers. Also accountable for submitting termination requests to all health plans in a timely manner.

Enter and maintain data in the credentialing database according to established data entry rules policies and procedures. Assists with maintaining the expirables tracking system

Maintain credentials files and related records according to established policies and procedures. Processes application requests from contracted entities; ensures correct application forms and complete packets are sent to provider; maintains tracking mechanisms

Updating of spreadsheets monitoring outstanding items for each client and providing updates to leadership client and team

Completion / Maintenance of CAQH applications

All job-related duties as assigned

What You Will Need :

High School Diploma / GED or 3 years of relevant equivalent experience in lieu of diploma / GED

1-3 years prior experience within payor / provider credentialing and / or enrollment.

What Would Be Nice To Have :

Knowledge of medical terminology

Strong verbal and written communication skills to effectively communicate with staff and client

Problem solving and critical thinking skills

Demonstrated proficiency researching credentialing guidelines

Detailed oriented with demonstrated accuracy organizational and time management skills

Ability to multitask and work independently

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The annual salary range for this position is $38000.00-$64000.00. Compensation decisions depend on a wide range of factors including but not limited to skill sets experience and training security clearances licensure and certifications and other business and organizational needs.

What We Offer :

Guidehouse offers a comprehensive total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include :

Medical Rx Dental & Vision Insurance

Personal and Family Sick Time & Company Paid Holidays

Position may be eligible for a discretionary variable incentive bonus

Parental Leave

401(k) Retirement Plan

Basic Life & Supplemental Life

Health Savings Account Dental / Vision & Dependent Care Flexible Spending Accounts

Short-Term & Long-Term Disability

Tuition Reimbursement Personal Development & Learning Opportunities

Skills Development & Certifications

Employee Referral Program

Corporate Sponsored Events & Community Outreach

Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity EmployerProtected Veterans Individuals with Disabilities or any other basis protected by law ordinance or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities or to apply for a position and you require an accommodation please contact Guidehouse Recruiting at 1- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouses Ethics Hotline. If you want to check the validity of correspondence you have received please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicants dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Required Experience :

IC

Key Skills

EMR Systems,Post Residency Experience,Occupational Health Experience,Pain Management,SOAP,Primary Care Experience,Medical Management,Suturing,Workers' Compensation Law,Pharmacy Residency,Botox Experience,Epic

Employment Type : Full-Time

Experience : years

Vacancy : 1

Monthly Salary Salary : 38000 - 64000