Job Title:
Credentialing Specialist – Medical Professionals
Job Summary:
The Credentialing Specialist ensures that medical professionals are properly accredited, licensed, and qualified to provide services to patients. They manage the process of verifying qualifications, maintaining compliance with insurance provider standards, and coordinating with both healthcare providers and insurance companies.
Key Responsibilities:
- Verify Credentials: Review and validate relevant medical degrees, board certifications, licenses, and malpractice history. Confirm training, education, and work history with the appropriate institutions or organizations.
- Provider Enrollment: Facilitate the enrollment of medical professionals with insurance providers and networks. Submit applications and follow up to ensure timely approval.
- Compliance Management: Ensure all providers comply with state and federal regulations as well as insurance company policies. Track expiration dates for licenses, certifications, and malpractice coverage, and notify providers of renewal deadlines.
- Record Keeping: Maintain accurate and up-to-date records in credentialing databases. Store documentation securely to comply with HIPAA and other privacy regulations.
- Liaising: Act as the point of contact between healthcare providers, insurance companies, and credentialing organizations. Respond to inquiries from providers and payers regarding credentialing status.
- Problem Resolution: Address and resolve discrepancies or issues in credentialing applications. Investigate and resolve delays or denials from insurance networks.
- Policy Development: Develop and update internal processes to streamline credentialing workflows. Stay informed about changes in insurance provider requirements and industry best practices.
- Auditing: Perform periodic audits to ensure records are complete and up to date. Prepare for inspections or reviews by regulatory agencies and insurers.
Qualifications:
Education:
- High school diploma or equivalent required.
- Bachelor’s degree in healthcare administration, business, or a related field preferred.
Certifications (Preferred):
- Certified Provider Credentialing Specialist (CPCS) or similar certification.
Experience:
- At least 1–3 years of experience in medical credentialing, provider enrollment, or a related healthcare/insurance role.
- Familiarity with credentialing software and database management.
Skills:
- Strong attention to detail and organizational skills.
- Excellent verbal and written communication.
- Proficiency with office software (e.g., Microsoft Office Suite) and credentialing systems (e.g., CAQH, PECOS).
- Ability to manage multiple tasks and meet deadlines.
- Knowledge of healthcare regulations (e.g., HIPAA, Medicare/Medicaid requirements).
Work Environment:
- Standard business hours with occasional overtime to meet deadlines.
- This role is critical in ensuring that healthcare organizations and insurance providers maintain high standards of care and compliance while minimizing risk.
Apply Here:
https://convergenceisrael.bamboohr.com/careers/44?source=aWQ9MjI%3D
