Credentialing and Compliance Specialist -Healthcare

Job Overview
We are seeking a detail-oriented and organized Credentialing and Compliance Specialist to join our team. The ideal candidate will be responsible for ensuring that our clinics and staff meet all necessary qualifications and standards required for credentialing. This role is crucial in maintaining the integrity of our medical office operations and supporting managed care initiatives. The Credentialing Specialist will work closely with various stakeholders to facilitate the credentialing process efficiently and accurately.

Key Responsibilities:

Ensure all standards are met as it pertains to each insurance company's policy and that our providers and locations are credentialed properly to maintain in network status.

• Credential Verification: They verify the qualifications, licenses, and certifications of healthcare providers (e.g., physicians, nurses, therapists) through primary source verification, ensuring the accuracy and validity of their credentials.
• Compliance:They ensure healthcare organizations and providers comply with federal, state, and local regulations, as well as those set by accrediting bodies (e.g., The Joint Commission).
• Provider Onboarding and Recredentialing:They manage the process of onboarding new providers and recredentialing existing providers to ensure their continued compliance and eligibility.
• Database Management:They maintain and update provider credential databases, ensuring accuracy and accessibility of information.
• Documentation and Record Keeping:They meticulously document all credentialing and compliance activities, maintaining a comprehensive record of each provider's status.
• Communication and Collaboration:They act as a liaison with various stakeholders, including providers, organizations, and regulatory agencies, to facilitate the credentialing process and address any compliance issues.

In essence, a credentialing and compliance specialist ensures that healthcare providers are qualified and compliant, contributing to a safe and effective healthcare environment.

Qualifications

• Strong understanding of medical terminology and healthcare practices.
• Experience in a medical office setting is preferred, particularly within managed care environments.
• Familiarity with credentialing standards and processes is highly desirable.
• Excellent organizational skills with a keen attention to detail.
• Ability to manage multiple tasks simultaneously while maintaining accuracy.
• Strong communication skills, both verbal and written, to interact effectively with healthcare professionals.
• Proficient in using computer systems for data entry and record management.

Join our team as a Credentialing Specialist where your expertise will contribute significantly to our commitment to quality healthcare delivery.

Job Type: Full-time

Pay: $22.00 - $26.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• Do you have experience in Medicare Compliance?
• Do you have credentialing experience?

Ability to Commute:

• Livonia, MI 48150 (Required)

Ability to Relocate:

• Livonia, MI 48150: Relocate before starting work (Required)

Work Location: In person

Salary : $22 - $26