Credentialing Specialist - Remote

Overview

Please be advised, if you are viewing this position on Indeed, that the salary rate/range set forth herein was provided by Indeed. Concentra's market specific rate/range will be provided during the interview process.

Credentialing Specialist performs all functions in support of onboarding to include initial credentialing,

recredentialing, and credentialing monitoring requirements including, but not limited to, performing a

comprehensive quality review of “non- standard” credentialing/re-credentialing, which includes those files with questionable clinical, quality and/or business issues, provider license monitoring, updates to

credentialing database from internal reports and notifications, and initiation of CAQH application process for initial credentialing, initiation of recredentialing process. Additionally, this position is responsible for assisting with the routing of files to and from the medical advisor and to and from the credentialing committee.

Responsibilities

• Distribute packets for CAQH data, payer documents and MARs packet to new hires
• Primary Source Verification of initial credentialing/re-credentialing files according to NCQA
  
  

Standards

• Appropriately identify and forward applicant initial and re-cred files which do not meet “standard”
  
  

requirements to medical advisor and/or credentialing committee, according to established

guidelines. Notify timely if any issues are identified and determine next course of action.

• Enter and maintain clinician demographic and credentialing information in credentialing database
  
  

(IntelliCred) obtained through credentialing application, primary source verifications, internal

reports, and notifications

• Facilitate creation and/or updating of CAQH applications for initial credentialing and
  
  

recredentialing when clinician is onboarding through new hire process or new business

development process.

• Participate in credentialing committee meetings to assure committee members have necessary
  
  

information, explain questionable information contained in file and act as overall resource for

general credentialing processes

• Conduct license monitoring process for all providers in accordance with licenses, certificate and
  
  

boards monitoring policy, to include initiation of letters, reports, and primary source verification of

renewals

• Identify issues in clinician's file that require committee review - create a medical review file and
• Obtain all requested data elements per committee chairman's request for file to be completed to
  
  

present to committee.

• Works with External Payer Credentialing and Medicare Enrollment teams on various credentialing
  
  

projects and internal interfacing processes.

• Submit information required to risk department to obtain COI prior to start date and in order to
  
  

complete file with high quality work in a quick and efficient turnaround time.

• Collaborate with recruiting, onboarding, risk management and hiring manager to complete prehire
  
  

clearance and credentialing process for start date to be confirmed

This job description is not designed to cover or contain a comprehensive listing of activities, duties or

responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Qualifications

Education Level: High School Diploma or GED

Major

Degree must be from an accredited college or university.

Education Details

Certifications and/or Licenses:

• Certified Professional Credentialing Specialist (preferred)
  
  

Experience in lieu of required education is acceptable: Yes

Continuing education is required to maintain license and to perform job: No

Customarily has at least the following experience: 1 year

• Minimum 1-2 years direct experience in credentialing required - CAQH experience preferred
• Certified Professional Credentialing Specialist certification preferred
• Knowledge of credentialing software (IntelliCred) is preferred
• Working knowledge of NCQA, URAC and/or AAHC credentialing standards
  
  

Additional Data

• 401(k) Retirement Plan with Employer Match
• Medical, Vision, Prescription, Telehealth, & Dental Plans
• Life & Disability Insurance
• Paid Time Off & Extended Illness Days Offered
• Colleague Referral Bonus Program
• Tuition Reimbursement
• Commuter Benefits
• Dependent Care Spending Account
• Employee Discounts
  
  

This job requires access to confidential and critical information, requiring ongoing discretion and secure information management.

We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

Concentra is an equal opportunity employer, including disability/veterans