Credentialing Specialist

Immediate need for a talented Credentialing Specialist. This is a 07+ months contract opportunity with long-term potential and is located in Philadelphia, PA (Hybrid). Please review the job description below and contact me ASAP if you are interested. 

Job ID: 25-89618

Pay Range: $40 - $43/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• The position requires review, understanding, and implementing new and changes in  credentialing and recredentialing requirements.
• Conducts pre-delegation assessment for onboarding new vendor.
• Review submitted rosters from delegates for accuracy and completeness
• Conducts Medicare Compliance Program Effectiveness audit (if applicable).
• Conduct annual credentialing/recredentialing audit files and policy and procedure review to meet accreditation standards and internal Credentialing guidelines.
• Creates reports regarding audits and analyzes tracks and trends audit findings.
• Develops and monitors corrective action plans (CAPs) and provides feedback to delegates on performance.
• Present audit findings and provide update on CAP status to the Delegation oversight Committee.

Key Requirements and Technology Experience: 

• Key Skills; Credentialing, CMS, NCQA
• 3-5 years of experience in regulatory, accreditation or compliance role within the health insurance, health, or managed care industry.
• Associate Degree in Business or Medical OR 4 years’ experience in directly involved in Credentialing operations performing delegated oversight activities.
• Experience in auditing Credentialing file or credentialing operational experience
• Must have knowledge and experience of regulatory, NCQA accreditation requirements and credentialing standards.
• Experience and knowledgeable in conducting a Medicare Compliance Program Effectiveness audit (preferred)
• Excellent Verbal and written communication skills.
• Organizational skills and the ability to handle multiple priorities.
• High attention to details
• Strong  PC proficiency to include Word, Excel, PowerPoint, Adobe Acrobat, and  Outlook.

Our client is a leading Health Insurance Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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