Credentialing Specialist

OrthoMed Anesthesia is seeking a detail-oriented and experienced Medical Credentialing Specialist to join our team. As a reputable healthcare organization, specializing in anesthesia, we prioritize maintaining a highly qualified and credentialed staff to ensure the delivery of quality care to our patients. This role is crucial in ensuring that all healthcare providers are properly credentialed and compliant with industry regulations.

Position: Medical Credentialing Specialist

Location: Addison, TX

Employment Type: Full-time

Responsibilities:

• Facilitate the credentialing and re-credentialing processes for healthcare providers, including physicians, nurses, and allied health professionals.
• Collect, review, and verify all necessary documentation and information required for credentialing, such as licenses, certifications, education, training, and work experience.
• Conduct primary source verification to ensure the accuracy and authenticity of provider credentials.
• Coordinate and communicate with healthcare providers, professional organizations, licensing boards, and insurance companies to obtain and verify credentialing information.
• Prepare and submit credentialing applications and supporting documentation to insurance companies, hospitals, and other relevant entities.
• Monitor and track the progress of credentialing applications, follow up on any delays or outstanding requirements, and escalate issues as needed.
• Maintain accurate and up-to-date provider credentialing files and databases.
• Stay current with industry standards, regulations, and guidelines related to provider credentialing and ensure compliance.
• Collaborate with internal departments, such as Human Resources and Compliance, to ensure alignment and adherence to credentialing requirements.
• Assist with audits, accreditation processes, and quality improvement initiatives related to provider credentialing.

Qualifications:

• High school diploma or equivalent; associate or bachelor's degree in healthcare administration or related field preferred.
• Proven experience as a Medical Credentialing Specialist or in a similar role within a healthcare setting.
• Knowledge of credentialing processes, regulations, and standards, including knowledge of CAQH and NPDB guidelines.
• Familiarity with various credentialing databases and software systems.
• Strong attention to detail and ability to work with complex documentation.
• Excellent organizational and time management skills to handle multiple provider applications and deadlines.
• Effective communication skills, both written and verbal, to interact with providers, insurance companies, and internal stakeholders.
• Ability to maintain confidentiality and handle sensitive information with professionalism and integrity.
• Proficient in using computer systems, including MS Office applications.

Join our dedicated team and contribute to ensuring the highest standards of provider credentialing and compliance. We offer a competitive salary, comprehensive benefits package, and opportunities for professional growth and development.

To apply, please submit your resume, cover letter, and any relevant certifications to office@orthomedstaffing.com. We appreciate your interest in joining our organization, and we will contact only those candidates whose qualifications closely match our requirements.

Please note that all applicants will be treated with confidentiality and that only selected candidates will be contacted for an interview.