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Provider Credentialing Specialist

Accede Solutions Inc (accedesol.com)

Role overview

Qualifications

  • High school diploma required; Associate's or Bachelor's degree preferred.
  • 2+ years of healthcare credentialing experience preferred.
  • Strong attention to detail.
  • Excellent organizational skills.

Responsibilities

  • Process initial credentialing applications.
  • Process re-credentialing applications.
  • Perform Primary Source Verification (PSV).
  • Review provider applications for accuracy and completeness.

Key facts

  • Remote from: Anywhere
  • Fixed term
  • Mid-level (2-5 years)
  • English

Hard skills

Other skills

  • Detail Oriented
  • Organizational Skills
  • Non-Verbal Communication
  • Time Management
  • Customer Service

About the company

Accede Solutions Inc (accedesol.com) logo

Accede Solutions Inc (accedesol.com)

Staffing & Recruiting

Accede Solutions is a Search firm providing services in multiple sectors. We have managed and Implemented Talent Acquisition and Talent Management processes and had successful engagement with clients in the areas of Financial Services, Technology, healthcare and professional services. We provide a full range of talent acquisition and management services designed to maximize the efficiency of your information management operation. From executive recruiting, to contract-to-hire placement, to contract employment, we offer solutions for your day-to-day workflow issues as well as workload spikes and special projects. We do also specialize in retained executive search focused on recruiting distinctive leaders and C level roles. With a track record of successfully recruiting key human capital leaders, we have earned a reputation for insightful and nuanced cultural advisory work built on a platform of strong capability supported by a rigorous and artful approach in assessing cultural fit. Accede Solutions Inc (www.accedesol.com) works with CEOs, CHROs, CPOs, CIOs, CMOs, heads of talent acquisition and other key stakeholders to develop thoughtful and strategic solutions around transitions in the human resources function. We are experienced in a range of industries, including retail/e-commerce, Financial Services, health & beauty, CPG, consumer goods, entertainment, telecom; Experienced search partner to small to mid-cap firms, growth-stage startups, private equity portfolio companies and non-profits.

Company details

Company typeSME
IndustryStaffing & Recruiting

Links

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Job description

Title: Provider Credentialing Specialist
Location - 100% Remote
Duration: 05+ months
Shift: M-F 09 AM to 06 PM

Position Summary
The Provider Credentialing Representative is responsible for performing day-to-day credentialing activities to ensure healthcare providers meet all regulatory, payer, and organizational requirements. This position completes credentialing and re-credentialing activities, performs Primary Source Verification (PSV), prepares provider files for committee review, and maintains accurate provider records.

Essential Responsibilities
• Process initial credentialing applications.
• Process re-credentialing applications.
• Perform Primary Source Verification (PSV).
• Review provider applications for accuracy and completeness.
• Request missing documentation from providers.
• Verify licenses, board certifications, DEA, malpractice coverage, education, and work history.
• Maintain accurate provider records within the credentialing system.
• Prepare provider files for committee review.
• Track credentialing deadlines and follow up on outstanding items.
• Communicate with providers regarding credentialing requirements.
• Escalate issues that may delay credentialing completion.
• Ensure compliance with CMS, NCQA, and organizational standards.
• Assist with audits and quality reviews.
• Maintain confidentiality of provider information.
• Meet departmental productivity and quality expectations.

Qualifications
• High school diploma required; Associate's or Bachelor's degree preferred.
• 2+ years of healthcare credentialing experience preferred.

Knowledge of:
o Initial Credentialing
o Re-credentialing
o Primary Source Verification (PSV)
o Healthcare credentialing documentation

• Strong attention to detail.
• Excellent organizational skills.
• Strong verbal and written communication skills.

Core Competencies
• Provider Credentialing
• Primary Source Verification
• Data Accuracy
• Time Management
• Customer Service
• Regulatory Compliance
• Documentation Review
• Organization
• Communication
• Team Collaboration

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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