Credentialing Specialist

Job not on LinkedIn

🔥 16 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 14%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Core Health LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🌍 Social Impact

Healthcare • Healthcare Insurance • Social Impact

Core Health LLC is a Health Services Management company specializing in managing at-risk patients, including the elderly, disabled, and those eligible for Medicaid and Medicare-Medicaid programs. The company collaborates with integrated health systems, Medicare Advantage Plans, and Accountable Care Organizations to enhance patient care in their communities. They also operate Health Alliance Connect, an integrated care program focused on seniors and individuals with disabilities.

📋 Description

• Partner with medical providers, hospitals, insurance companies, operations leaders, and other stakeholders to ensure providers are credentialed • Manage all aspects of hospital and financial credentialing processes for new hires and existing providers • Handle credentialing documentation, communication, monitoring, and compliance with credentialing specifications • Stay abreast of credentialing and recredentialing requirements for each client group • Request, review, and verify credentialing applications and supporting documentation • Establish and maintain databases of provider details and credentialing data • Monitor provider license and certification expirations to ensure timely renewals • Notify providers and administration of upcoming expirations and documentation requests • Collaborate with hospitals, insurance companies, and other stakeholders to provide information and track the credentialing process • Provide status updates to operations leaders, providers, and other stakeholders • Resolve issues and escalate when appropriate • Perform other duties as assigned

🎯 Requirements

• High School Diploma or GED required • Prior administrative experience in a healthcare environment • Medical credentialing experience preferred • Experience with MS Outlook, Word, and Excel • Experience with MS Teams and credentialing software preferred • Knowledge of credentialing requirements and workflows for providers at differing client groups • Familiarity with healthcare jargon and terminology related to credentialing • Excellent verbal and written communication skills • Excellent interpersonal and customer service skills • Proficiency in Microsoft Office and credentialing-related software • Excellent organizational skills and attention to detail • Ability to work independently and exercise judgment in decision-making and issue resolution • Ability to navigate competing priorities and work effectively in a fast-paced environment • Ability to manage information flow in a timely and accurate manner • Ability to collaborate with professionals at various client groups and geographic locations • Ability to identify and execute opportunities for improvement • Growth mindset and team-oriented behaviors