Credentialing Specialist_Corp. Remote

Preventive Measures, LLC. is an outpatient psychiatric facility with multiple locations within the USA. We provide members of our local communities’ access to necessary mental health treatment. If you want to be part of an excellent, forward-thinking, and growing company, apply today!

Summary:  A credentialing specialist is a healthcare administrative professional responsible for verifying and maintaining the validity of medical staff members' licenses, certifications, and credentials by tracking renewal dates, ensuring compliance with regulatory requirements, and advising healthcare providers on necessary documentation to maintain their practice license within legal parameters; essentially, they act as a gatekeeper to ensure only qualified medical professionals can practice within a healthcare facility.

Interrelationship: Must be able to communicate with various Preventive Measures staff and other professionals to navigate needs effectively.

Primary Job Responsibilities:

• Gathering and reviewing documentation
  • Collect and thoroughly review provider applications, licenses, certifications, malpractice insurance information, and other necessary documents to verify their authenticity and compliance with standards.
• Data entry and maintenance
  • Input provider data into credentialing databases, ensuring accuracy and updating information as needed.
• Credentialing process management
  • Manage the entire credentialing process, including initial application review, primary source verification, and follow-up with providers for missing information.
• Compliance monitoring
  • Stay updated on current credentialing regulations and standards, ensuring the healthcare facility adheres to all applicable laws and guidelines.
• Renewal tracking
  • Monitor provider license and certification expiration dates, notifying providers well in advance to facilitate timely renewals.
• Communication with providers

Communicate with healthcare providers regarding credentialing status, required documentation, and any issues that may arise during the process

• Payer credentialing
  • Submit provider information to insurance payers for credentialing purposes, ensuring timely processing and network access.
• Quality assurance
  • Perform quality checks on credentialing data to maintain accuracy and identify potential errors.
• Other duties and responsibilities as assigned.

Job Skills:

• Attention to detail

1. Essential for accurately reviewing and verifying complex medical documentation.

• Organizational skills:
  1. Ability to manage multiple tasks and deadlines efficiently while maintaining organized records.
• Communication skills:
  1. Clear and effective communication with healthcare providers, administrative staff, and insurance companies.
• Research skills:
  1. Capability to research and interpret regulatory requirements and medical licensing information.
• Computer proficiency:
  1. Familiarity with credentialing software and databases.

Education/Experience: 

Company website: https://preventivemeasuresinc.com/

Preventive Measures is committed to equal opportunity for all employees and applicants. As a proud Equal Opportunity Employer (EOE), we do not discriminate based on race, color, national origin, ancestry, citizenship status, religion, sex, sexual stereotyping, sexual orientation, gender, gender identity, gender expression, age, marital status, mental or physical disability, medical condition, genetic information, military or veteran status, pregnancy (which includes pregnancy, childbirth, and medical conditions related to pregnancy, childbirth, or breastfeeding), or any other protected characteristic. Employment may be contingent upon receipt of and passing all job-related clearances, background checks and regulated requirements as applicable and permissible by law.