Credentialing Specialist

• Application management and verification activities, preliminary analysis of application and verification information, and analyzing verification information, to include identifying red flag and/or adverse information
• Maintain timely communication with applicants and member organizations on the status of the application files and any required documents or information needed to complete the medical credentialing process
• Monitoring expiring information such as, but not limited to, federal and state DEA, state professional license(s), professional liability insurance, and specialty board certification status
• Timely and accurately prepare credential files for audit and submission to assigned facilities
• Compliance with standard turn-a-round times
• Maintain a working knowledge of relevant regulatory standards (i.e., TJC, AAAHC, DNV and NCQA), state and federal requirements and CMS
• Assist with the development and implementation of credentialing and re-credentialing workflows to ensure efficient and effective alignment of processes and assist in the development or revision of credentialing related forms
• Participation in special project teams as assigned

• Associate Degree preferred, High School diploma or GED required
• 3-5 years related work experience required in CVO or other credentialing setting
• Certified Provider Credentialing Specialist (CPCS) required
• Experience with computer systems required, including web-based applications and some Microsoft Office applications which may include Outlook, Word, Excel, and credentialing database
• Knowledge of credentialing software and associated applications
• Experience with credentialing verification and application audit process
• Ability to make decisions that are guided by general instructions and practices requiring some interpretation
• Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents
• Ability to follow policies and procedures
• Ability to communicate clearly and effectively with internal and external customers
• Ability to comprehend and converse to communicate effectively assigned facilities
• Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies
• Ability to work collaboratively in small teams

Work Flex program which gives you the opportunity to work at our Chesterfield office, our Downtown St. Louis office, remotely, adopt a hybrid approach or even switch between these options as you prefer