Credentialing Specialist Job at Robert Half (Fresno)

Credentialing Specialist

We are looking for a detail-oriented Credentialing Specialist to join our team o...

Location

United States , Henderson

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in credentialing, particularly in a healthcare or hospital setting
Proficiency in using credentialing databases, CRM systems, and EHR platforms
Familiarity with the Council for Affordable Quality Healthcare (CAQH) process
Strong knowledge of medical terminology and credentialing standards
Exceptional organizational and auditing skills with high attention to detail
Ability to manage multiple tasks and meet strict deadlines
Certified Provider Credentialing Specialist (CPCS) designation preferred
Proficiency in tools like Adobe Acrobat and Microsoft Office Suite

Job Responsibility

Manage the credentialing process by collecting, reviewing, and verifying applications and supporting documentation
Ensure all physician credentials are accurate, complete, and comply with applicable regulatory standards
Maintain up-to-date records in the credentialing database and other tracking systems
Collaborate with healthcare providers and organizations to resolve discrepancies or incomplete information
Conduct audits to verify compliance with internal policies and external regulatory requirements
Provide support for enrollment with the Council for Affordable Quality Healthcare (CAQH) and other accrediting bodies
Prepare detailed reports on credentialing activities and compliance status
Assist in identifying and implementing improvements to the credentialing process
Stay informed about changes in healthcare credentialing regulations and best practices

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Fulltime

Provider Credentialing Specialist

Work with the New Ventures team to complete health plan credentialing accurately...

Location

United States

Salary:

55000.00 - 75000.00 USD / Year

Pomelo Care

Expiration Date

Until further notice

Requirements

2-4 years of experience in a high volume, credentialing specialist role
Deep expertise with commercial health plan credentialing processes, including health plan portals & CAQH
Highly organized with a strong attention to detail
A proactive and resourceful problem-solver who is comfortable navigating ambiguity and independently seeks out answers and solutions
An accountable and collaborative team player with excellent communication skills, both written and verbal
An expert at prioritization & time management, who proactively shares deliverable timelines and roadblocks

Job Responsibility

Complete group & practitioner health plan credentialing on behalf of Pomelo’s telehealth clinic & care team
Track applications from submission to approval, contracting, and agreement, ensuring cross-functional visibility into key milestones & timelines
Proactively mitigate application delays & denials
Rigorously follow up on any delays and/or denials to right-size
Collaborate with Pomelo licensing, credentialing, and enrollment team to ensure proper clinician licensure & up-to-date CAQH profiles, to help expedite health plan credentialing
Collaborates with care team of nurses, nurse practitioners, doctors, therapists & registered dietitians to support navigation & answer questions about clinician credentialing applications

What we offer

Competitive healthcare benefits
Generous equity compensation
Unlimited vacation
Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)

Medical Staff Credentialing Specialist and Coordinator

The Medical Staff Credentialing Specialist and Coordinator assists the Medical D...

Location

United States , Medina

Salary:

50000.00 - 60000.00 USD / Year

Orleans Community Health

Expiration Date

Until further notice

Requirements

Associates Degree or Certified Provider Credentialing Specialist (CPCS)
A minimum of 2-3 Years Credentialing experience is preferred
Excellent verbal and written communication skills, ability to relate well with people of diverse backgrounds, training and experience
Proficiency with medical practice software programs, Familiarity with credentialing requirements of hospitals and insurance carriers
Understanding of Malpractice insurance coverages and policies
Knowledge and understanding of credentialing process
Ability to organize and prioritize work and manage multiply priorities
Ability to research and analyze data
Ability to work independently with minimal supervision
Ability to establish and maintain effective working relationships with providers, management, staff and external contacts

Job Responsibility

Compiles and maintains current and accurate data for all providers
Completes provider credentialing and re-credentialing applications, monitors applications and follow-up as needed
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
Maintains corporate provider contract files
Maintains knowledge of current health plan and agency requirements for credentialing providers
Sets up and maintains provider information in online credentialing databases and system
Tracks license and certification expirations for all providers to ensure timely renewals
Ensures practice addresses are current with health plans, agencies and other entities
Audits health plan directories for current and accurate provider information
Completes credentialing/re-credentialing application packets for hospital, insurance carriers and government programs

What we offer

vacation and sick time
health, dental and vision
pension and retirement plan
competitive wages, with superior pension and retirement plans with employer contributions
12% shift differential for working evening and night shifts
excellent vacation, holiday and sick leave package
tuition assistance
free parking

Fulltime