Position Summary
The Credentialing Specialist ensures clinicians successfully pass the credentialing process. This role is responsible for assisting clinicians with the completion of their credentialing applications , performing primary source verifications , and maintaining the MD Staff credentialing database. The Specialist must ensure all credentialing functions comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements. This position reports to the Credentialing Supervisor.
Key Responsibilities

• Review and process credentialing and re-credentialing files.
• Establish and maintain a system for the timely processing of credentialing files in accordance with NCQA policies.
• Query appropriate organizations and evaluate responses to ensure provider compliance with NCQA standards.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.
• Review all background checks, drug tests, and TB screenings and record the results.
• Assemble all verified information and prepare files for presentation to the Credentialing Committee.
• Verify providers requirements for approval to work in specific states and plans.
• Assist with the ongoing monitoring of contracted clinicians.
• Utilize the MD Staff credentialing database to perform queries, generate reports, and optimize efficiency.
• Provide administrative support to department leadership and both internal and external stakeholders.
• Maintain professionalism at all times 17and provide timely, professional responses to all emails.
• Actively demonstrate teamwork and assist with special projects.
• Responsible for the security and privacy of any protected health information (PHI) accessed during work activities.

Required Qualifications

• 1-3 years of successful work experience in a credentialing role/department.
• Intermediate skills with Google Suites.
• Must be familiar with NCQA accreditation standards.
• Demonstrate active listening skills and the ability to provide and receive constructive feedback
• Strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders

Preferred Qualifications

• Obtain NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) within 2 years of eligibility to certify.
• Working knowledge of problem-solving and decision-making skills.
• Ability to organize and prioritize workload and day-to-day tasks.

Education
High school diploma or up to 1 year of equivalent experience.