Credentialing Specialist I
Bcidaho

Job Info

---

Our Credentialing Specialist will process initial and renewal applications for provider credentials. Ensure contracting providers meet credentialing standards. Provide education and maintains relationships with providers regarding credentialing standards and processes.

*This will be on on-site or hybrid position. Must be located in the Treasure Valley area.

We're looking for Credentialing Specialist with:

• 2 years within health industry setting such as billing, credentialing, or state medical regulatory agency
  
• Education: High School or equivalent
  

What a day would look like:

• Maintains provider credentialing system and communicates with provider regarding status/information.
  
• Prepares and provides reports/documentation for audits requested by regulating bodies.
  
• Maintains all credentialing documentation, including sensitive provider background information, to ensure Company, Federal, and State regulatory requirements are met.
  
• Prepares documentation for presentation to Credentialing Committee. Tracks and reports on follow-up items to include appeal and hearing processes.
  
• Collaborates with key departments to ensure provider remedial action plans are implemented, tracked, and reported.
  
• Makes recommended changes to policies, procedures, and/or processes and ensure they meet company and regulatory requirements.
  
• Meets department metric targets to maintain service level for providers.
  
• Performs quarterly review and annual audits.
  
• May conduct on-site visits during the credentialing process.
  
• May report adverse credentialing actions to appropriate agencies.
  
• Performs other duties and responsibilities as assigned.
  

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

This job has expired.