Credentialing Specialist

Eugene, OR 97401

Posted: 10/10/2019 Industry: Clerical Job Number: 10101901 Pay Rate: $17-$19/hr DOE

Job Description

Job Summary

At Quantum Recruiters we focus intently on providing talent to leading employers throughout the Pacific Northwest.  For over 80 years, our client has built a reputation based on taking great care of people by delivering health plans to individuals and businesses throughout the Northwest. We are currently recruiting to fill an immediate need for experienced Credentialing Specialists to join their team. Our client offers an ‘employee-centric’ work environment, incredible benefits package and opportunities for advancement.


Position Overview

Responsible for obtaining and maintaining critical provider credentialing data necessary for initial and recredentialing reviews to determine participatory status, ensuring selection of providers who possess and maintain the clinical skills necessary to deliver high quality of healthcare and service excellence to our client’s members. Follow credentialing procedures, accreditation and regulatory requirements to ensure timely, accurate credentialing of practitioners. Maintain current credentialing information and frequent communication with practitioners regarding credentialing issues and practice information.


Essential Responsibilities

  • Input and maintain practitioner data in computer database. Review, research and verify practitioner files and computer database records to obtain information and compile data for reports.
  • Perform essential credentialing activities related to credentialing and recredentialing operations. Organize project work, maintain inter-departmental contacts regarding credentialing issues, and maintain credentialing status report.
  • Conduct primary source verification on applicants, which may include but is not limited to: making requests, investigations, verifications of multiple documents, tracking and follow-up of responses from all required sources as required by accreditation and regulatory requirements and credentialing policies and procedures.
  • Maintain familiarity with requirements of National Practitioner Data Bank (NPDB), State Medical Boards, the National Committee of Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), our client’s credentialing policies and procedures and other requirements as applicable.
  • Manage and respond to high volume internal and external customer inquiries and correspondence via email, telephone and in person.
  • Collaborate and work cohesively in a team environment with reassignment of primary job responsibilities and duties as necessary to ensure high productivity and work process efficiency.
  • Maintain collaborative relationships and act as liaison between our client and IPAs/Delegates, practitioners and their staff and other contacts to ensure excellent customer service and accurate information is obtained and entered in the system.
  • Review monthly reports to ensure all practitioners complete recredentialing in accordance with the assigned target date. Perform projects including generation and review of reports and data entry corrections to improve system integrity and compliance.
  • Prepare reports and written summaries on practitioners with adverse actions identified during the credentialing process for the Credentialing Committee and develop meeting materials in preparation of the monthly meeting.
  • Maintain strict confidentiality of all practitioners’ records, data, correspondence and occurrences.

To be considered for this excellent opportunity, please submit resume. All inquiries kept strictly confidential.

Quantum Recruiters is committed to Affirmative Action and values diversity in its workforce

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