Job Details

Job Description:

Pay Range: $22.14hr - $27.14hr

• nalyze credentialing applications and perform primary source verification of credentials.
• Determine appropriate network participation and obtain executed contracts to formalize provider relationships.
• Respond to internal and external inquiries regarding provider participation, credentialing, and status updates.
• Maintain provider files and update MDStaff and electronic records for credentialing, recredentialing, demographic updates, and terminations.
• Identify, analyze, and resolve provider file issues, ensuring data integrity and proper system integration.
• Prepare written requests and follow up with providers to obtain missing information.
• Ensure compliance with state laws, departmental guidelines, and corporate procedures.

• Minimum 3 years of experience in physician credentialing or health insurance/managed care operations (customer service, claims, billing, enrollment, or call center environment).
• Proficiency in Excel, including pivot tables.
• Excellent verbal and written communication and interpersonal skills.
• Knowledge of medical terminology.
• bility to interpret jurisdictional requirements and apply reasoning to verification processes.
• Strong attention to detail and adherence to standard operating procedures.

• High School Diploma required.
• Bachelor's degree in Business, Healthcare Administration, or related field preferred.

• Certified Provider Credentialing Specialist (CPCS) certification.