Credentialing Specialist jobs in Springfield, MA

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POSITION:         Credentialing Specialist
SCHEDULE:       Full-Time, Monday-Friday 9AM-5PM
FACILITY:           WHS Corporate office
LOCATION:        Green Tree – Pittsburgh, PA
*onsite position*

POSITION SUMMARY
The Credentialing Specialist conducts and facilitates, on an ongoing basis, the credentialing of all professional employed staff and contracted providers to include initial appointments, reappointments and the maintenance of documents.

BENEFITS
•    Annual review with performance increase
•    Generous paid-time off program that combines vacation and sick leave
•    Paid holidays
•    Comprehensive health insurance through Blue Cross Blue Shield
•    Dental and Vision insurance
•    401(k) retirement saving plans
•    Company-paid short-term disability
•    Healthcare and dependent care spending account

DUTIES/RESPONSIBILITIES:
1.    Professionally handles confidential information.
2.    Processes professional staff and on-site contracted provider appointments/reappointments which including obtaining copies of all current documents, entering physician data into the Credentialing database, send/track/follow-up on primary source verification letters, scanning documents, and copying files to be sent to facilities.
3.    Processes professional network providers’ appointments/reappointments including obtaining copies of all current documents, entering physician data into the Credentialing database, send/track/follow-up on primary source verification letters, and copying files to be sent to facilities.
4.    Verifies licenses and runs NPDB reports on candidates.
5.    Generates reports related to expired documents and reappointments.
6.    Assists with processing new license applications for Chief Medical Officer, Regional Medical Directors and UM Physician as needed. 
7.    Tracks delinquent licenses/malpractice, performs and follows-up on monthly reminder letter mailings, provides updated licenses and certifications to facilities as needed.
8.    Assists with research related to RFP development as needed.
9.    Works closely with provider contract specialists and Staffing to credential candidates efficiently.
10.    Follows-up per credentialing policies and procedures during appointment/reappointment process when notified of possible lawsuits or credentials issues.
11.    Maintains credential files.
12.    Provides credentialing information to facilities for audits, meetings, inspections, etc.
13.    Assists with drafting and revising policies related to the credentialing process.
14.    Interacts professionally and supports all levels of staff in corporate and regional locations. 
15.    Maintains logs and key information in databases as necessary for data collection and tracking purposes.
16.    Files and tracks physician peer reviews.
17.    Performs department related research.
18.    Prepares all documents and files for monthly credentialing meetings.
19.    Assumes other duties as assigned and directed. 
The duties and responsibilities outlined herein are for payroll purposes only; employees may be assigned other duties as required.

JOB REQUIREMENTS
The following requirements list the minimum to qualify.  An equivalent combination of education and experience may be accepted.
LICENSING: None Required
CERTIFICATION: None
EDUCATION:  High school diploma, Associates degree preferred.  
PREFERRED SKILLS/EXPERIENCE:

• Minimum of two years providing clerical, secretarial or administrative support, preferably in a medical office but preferentially in a credentialing setting.

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