Enterprise Credentialing Specialist: Enterprise Credentialing

Primary Duties And Responsibilities

• Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.
• Create and carry out credentialing processes for physicians, other healthcare professionals, and sites.
• Assist the Supervisor in ensuring that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
• Process applications and reappointment paperwork, verifying completeness and accuracy.
• Collect and process significant amounts of verification and accreditation information.
• Maintain and update accurate databases for practitioners and facilities, including education, training, experience, and licensure information.
• Prepare records for regular auditing.
• Maintain close communication with practitioners to ensure records are up to date and consistent.
• Demonstrate behaviors consistent with core values and comply with all required standards.

Education and Experience

• High School diploma, GED, California High Proficiency or equivalent work experience
• Proficiency with Microsoft Office Products (Word, Excel, PowerPoint)
• Experience specific to NCQA standards preferred
• MD Staff experience preferred
• Proficiency with medical terminology preferred

License Required:

• N/A

License Preferred:

• N/A

Certifications Required

• N/A

Certifications Preferred

• Certified Professional Credentialing Analyst (CPCS)
• Certified Professional Medical Services Professional (CPMSM)