Position Title: Credentialing Specialist
Location: Las Vegas NV
Contact Information: Holly Gavin, hgavin@pmclv.com
Position Description:
- Responsible for all aspects of the credentialing, re-credentialing and privileging processes for medical providers. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
- Compiles and maintains current and accurate data for all providers
- Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
- Maintains corporate provider contract files
- Maintains knowledge of current health plan and agency requirements for credentialing providers
- Tracks license and certification expirations for all providers to ensure timely renewals
- Ensures practice addresses are current with health plans, agencies and other entities
- Audits health plan directories for current and accurate provider information
- Maintains confidentiality of provider information
- Provides credentialing and privileging verifications
- Performs other duties as assigned
SKILLS:
- Knowledge and understanding of the credentialing process
- Ability to organize and prioritize work and manage multiple priorities
- Excellent verbal and written communication skills including, letters, memos and emails
- Excellent attention to detail
- Ability to research and analyze data
- Ability to work independently with minimal supervision
- Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization
- Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources
QUALIFICATIONS:
- High school diploma or equivalent
- Two years of relevant credentialing experience in Nevada
