Credentialing and Privileging Specialist

Job not on LinkedIn

🔥 14 hours ago

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $21 - $34 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 $5M Grant on 2021-05

Insurance • Consulting • Logistics

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Coordinate and implement credentialing and privileging activities within the Credentialing and Privileging Office • Manage appointment, reappointment, and ongoing verification activities for Medical Staff and Allied Health Professional Staff • Investigate and document practitioner credentials, including background, training, and past practice • Review appointment and reappointment applications for accurate and appropriate data • Determine primary sources for verifications and document verification in practitioner files • Perform follow-up and second-source verification when necessary • Verify practitioners meet criteria for requested privileges and perform focused professional practice evaluations, reappointments, status or privilege changes, and temporary privileges • Evaluate verifications for discrepancies and investigate questionable information • Notify supervisors and management of adverse or questionable verification responses • Create scanned references of adverse or potentially adverse information for facility downloads when appropriate • Document verification and inquiry results according to regulatory standards and entity agreements • Maintain credentialing and privileging software for tracking queries, verification methods, privilege information, and related activities • Maintain Medical Staff and Allied Health Professional Staff credential files • Assist with monthly Credentials Committee and Allied Health Professional Subcommittee agendas • Handle customer questions and complaints • Perform other duties as assigned or required

🎯 Requirements

• High School / GED • 3 years of general office administration work in a business, education, or healthcare environment • Knowledge of credentialing and privileging requirements of the Department of Health, Joint Commission, NCQA, URAC and other governmental requirements • Preferred: Associate's Degree • Preferred: 3 years with physician credentialing and privileging, medical education, hospital environment, health insurance or managed care • Preferred: 1 year in customer service • Preferred: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) • Compliance with HIPAA, data security guidelines, company policies, applicable laws, rules, regulations, and training requirements

🏖️ Benefits

• Remote work • Base pay range of $21.97–$34.39 per hour • HIPAA and privacy/security policy training and compliance support • Accessibility and application accommodation support