About this role
This role coordinates and reviews healthcare provider credentialing activities to ensure completeness, accuracy, and compliance with federal, state, and facility requirements. The specialist also supports security and background check processes and maintains credentialing data and reporting.
Key Responsibilities
- Coordinates and reviews provider files for completeness, accuracy, and compliance with federal, state, and facility regulations
- Monitors provider files to ensure completeness and accuracy
- Coordinates and reviews provider security and background check documents for completeness, accuracy, and compliance
- Prepares, issues, electronically tracks and follows-up on verifications with providers
- Enters, updates, and maintains data from provider files into credentialing database and prepares/analyzes reports
Technical Overview
The position centers on credentialing workflow management, including research on updated regulations, coordination of security/background check documentation, and electronic tracking of verifications. It requires strong data handling in a credentialing database and preparation of compliance reporting.
Ideal Candidate
The ideal candidate is a compliance-focused credentialing professional with at least 5 years of credentialing experience, comfortable reviewing provider files for completeness, accuracy, and regulatory compliance. They have experience managing security and background check processes (preferably federal background investigation requirements and Department of Veterans Affairs requirements) and can maintain credentialing databases with strong attention to detail and clear communication.
Must-Have Skills
Credentialing experience (minimum 5 years)Evaluateanalyzeand coordinate all aspects of the credentialing process for healthcare providersCoordinate and manage security and background check processes with candidates via remote correspondenceCoordinates and reviews provider files for completenessaccuracyand compliance with federalstateand facility regulationsguidelinespoliciesand standards
Nice-to-Have Skills
Prior government contracting experienceExperience navigating federal background investigation requirementsParticularly the requirements of the Department of Veterans Affairs
Tools & Platforms
credentialing databaseelectronic tracking
Required Skills
credentialingprovider files reviewbackground checksecurity process documentscompliance with federal state and facility regulationselectronically track verificationsfollow-upcredentialing database data entryreport preparationcommunicate with providers and liaisons
Hard Skills
CredentialingProvider credentialing files reviewCredentialing process coordinationSecurity process document coordinationBackground check processesState regulations researchFederal regulations researchFacility regulations complianceElectronic verifications trackingFollow-up verifications with providersData entryupdatingand maintenance in credentialing databaseReport preparation and analysisData reporting and findings communicationCommunicating with providers and liaisonsPrivileging matters supportFast-paced prioritizationDatabase management for credentialing
Soft Skills
Highly developed oral communication skillsHighly developed written communication skillsHighly organizedStrong time management skillsClear communicationCustomer service mindsetAbility to support multiple team members and projects simultaneouslyPrioritization in a fast-paced environmentCoordination and collaboration
Keywords for Your Resume
Compliance & Credentialing Specialistcredentialing experiencecredentialing processprovider filescompletenessaccuracycompliance with federalcompliance with statecompliance with facility regulationsbackground checksecurity and background check documentselectronically trackfollow-upverificationscredentialing databaseenterupdatemaintain datareports and datacommunicate findingsprovidersliaisonsDepartment of Veterans Affairsfederal background investigation requirementsgovernment contractingcredentialingstateand facility regulationssecurity process documentselectronic tracking
Deal Breakers
Must have a minimum of 5 years of credentialing experience, Must be eligible to work in the United States, Must be able to accurately handle security and background check processes for candidates via remote correspondence
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