Credentialing Specialist - Physician Healthcare

Job Family:

Patient Account Representative Credentials

Travel Required:

None

Clearance Required:

None

What You Will Do:
 

The Credentialing Specialist is responsible for coordinating, processing, monitoring, and maintaining the initial and reappointment confidential credentialing process for designated providers.  Ensures timeliness and compliance with client standards and compliance as well as all legal and regulatory requirements.  The Credentialing Specialist is responsible for accuracy and integrity of the credentialing database system either client owned or Guidehouse credentialing system. 

• Monitor and ensure compliance with company and client standards

• Strong understanding of credentialing software software/systems used

• Gather, verify, and evaluate healthcare provider credentials for initial and recredentialing applications; identify potential issues; determine if further investigation or information is necessary and make appropriate inquiries; assess completed applications

• Responsible for ensuring timely enrollment of new providers with 3rd party and government payers; and maintenance of existing active physicians and advanced practice providers. Also, accountable for submitting termination requests to all health plans in a timely manner.

• Enter and maintain data in the credentialing database according to established data entry rules, policies, and procedures. Assists with maintaining the expirables tracking system

• Maintain credentials files and related records according to established policies and procedures. Processes application requests from contracted entities; ensures correct application forms and complete packets are sent to provider; maintains tracking mechanisms

• Updating of spreadsheets, monitoring outstanding items for each client, and providing updates to leadership, client, and team

• Completion/Maintenance of CAQH applications

• All job-related duties as assigned

What You Will Need:

• High School Diploma/GED or 3 years of relevant equivalent experience in lieu of diploma/GED

• 1-3+ years prior experience within payor / provider credentialing and/or enrollment.

What Would Be Nice To Have:

• Knowledge of medical terminology

• Strong verbal and written communication skills to effectively communicate with staff and client

• Problem solving and critical thinking skills

• Demonstrated proficiency researching credentialing guidelines

• Detailed oriented with demonstrated accuracy, organizational and time management skills

• Ability to multitask and work independently

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The annual salary range for this position is $38,000.00-$64,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

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