Credentialing Specialist

Position Summary: 
This position is responsible for coordinating and implementing activities related to the credentialing and privileging of the Revere Health Medical Staff in accordance with facility requirements, health plan requirements and other relevant standards
including NCQA, CMS and URAC. 

Essential Job Functions: Works closely with contracted health plans and healthcare facilities to credential providers and assist providers in obtaining and maintaining facility privileges and plan network participation. Assists providers in maintaining state licensure, DEA licensure, and renewing individual and group malpractice insurance. Responsible for the accuracy and integrity of the provider data. Responsible for the evaluation of credentialing and re-credentialing files. Accurately analyzes the provider data to assure that all applicable requirements have been satisfied. Identifies any additional information needed, performs all necessary follow-ups, and investigates any missing, incomplete, or unclear information in preparation for submission and review. Manages and coordinates the credentialing/re-credentialing process for Revere Health Providers, which includes primary source verification including but not limited to the National Practitioner Data Bank, state licensing departments, malpractice insurers, educational institutions, board certifications and OIG sanctions list. Works closely with team members in coordinating efforts and maintaining
a high level of performance in the department. 

Qualifications:  

• Excellent interpersonal skills 

• Excellent computer skills 

• Excellent organizational skills 

• Excellent communications skills both verbal and written 

• Ability to communicate diplomatically with providers, administrators, facility representatives and payor partners 

• Ability to work effectively under time constraints to meet deadlines 

• Ability to manage projects in an effective and organized manner 

• Heightened attention to detail 

• Experience as professional support in medical field or medical staff services preferred 

Hours: M-F 8am - 5pm. In office position