Responsibilities of the Senior Credentialing Specialist
- Perform the auditing of credentialing and recredentialing files.
- Responsible for performing the auditing of credentialing and recredentialing files.
- Responsible for performing the ongoing audits for those provider groups
- Ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.
- Perform other ad hoc duties.
Requirements of the Senior Credentialing Specialist
- Associate's degree
- 3 year experience as a Credentialist
- Expert knowledge of NCQA standards and payer credentialing standards required
- Previous experience working with CAQH required
- Knowledge of vision, dental or hearing industry preferred
- Excellent interpersonal, oral and written communication skills required
- Critical thinking, detail oriented and strong organizational skills required