Credentialing Specialist

Healthcare's helping hand.

CHG shook things up in 1979 by inventing the locum tenens staffing model.

We connect doctors with patients who need their care.

As the largest physician staffing firm in America, our providers treat millions of patients each year.

Our industry is growing and demand is high.

This means you'll have plenty of opportunities to grow and develop in your career.

Keeping healthcare healthy can be as fun as it is rewarding

The Credentialing Specialist is responsible for credentialing and recredentialing client practitioners as well as ensuring enrollment with participating client health plans.

Credentialing functions include, but are not limited to, processing credentialing applications, performing primary source verifications and updating and maintaining credentialing database in accordance with internal policies and procedures, client health plan contracts and applicable state and federal requirements.

Responsibilities


* Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for payor enrollment and credentials verification process


* Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s)


* Enroll providers with client payors to include Medicare, Medicaid and state and federal commercial health plans and follow up as required until process complete


* Update CAQH and NPI information consistent with client practice information


* Responsible for gathering, verifying evaluating highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standards


* Respond to all practitioner, client health plan and internal inquiries in a timely manner


* Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed timeframe


* Maintain practitioner paper and electronic data files for clients; utilizing CAQH to submit practitioner data as required to credential individual practitioners


* Collaborate with participating clients in a professional manner, department manager and/or external agencies to facilitate and ensure smooth hand-off during the credentialing process


* Follow up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process


* Perform all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner files


* Conduct sanctions and compliance monitoring and alert Manager of any undisclosed negative findings immediately


* Participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency


* Contribu...