Credentialing Specialist

Job not on LinkedIn

🔥 2 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $24 - $36 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Point32Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Point32Health is a leading nonprofit health and well-being organization that provides health coverage and services for individuals at all life stages. Through its family of companies, including Harvard Pilgrim Health Care and Tufts Health Plan, Point32Health offers a variety of health plans, programs, and services encompassing medical, pharmacy, wellness, and behavioral health. Point32Health is committed to health equity and has been recognized for its inclusive practices, earning distinctions in areas such as health equity, disability inclusion, and LGBTQ+ workplace inclusion. With a focus on innovative solutions and high-quality coverage, Point32Health strives to create a better healthcare experience for its members and communities.

📋 Description

• Maintain and process physician and provider credentialing information for new and established health plan practitioners • Assess adequate and accurate participation information, including provider contract information • Enter initial and existing credentialing applications into the Cactus credentialing information system • Verify licenses, board certification, and other required credentials through various sources • Review and report adverse information from the National Practitioner Data Bank and state/federal sanctions • Retrieve missing or expired information and documentation required for credentialing • Serve as a resource for physician and provider questions about certification and credentialing • Identify complex or sensitive issues for the Credentialing Supervisor and potential review by a Medical Director or outside source • Prepare files meeting credentialing criteria for Credentialing Compliance Coordinator/Supervisor review and Medical Director file review • Prepare files not meeting criteria for Medical Director, Senior Credentialing Specialist, or Supervisor review and Quality-of-Care Committee presentation • Process practitioners under entity agreement terms, including files credentialed through a Certified Verification Organization • Participate in assigned task forces and meetings • Perform other assigned duties and projects

🎯 Requirements

• High school diploma required • 1-2 years of experience in healthcare field • Experience with personal computer • Ability to appropriately identify emergency situations and follow the appropriate protocol • Ability to maintain and manipulate a complex credentialing information system • Ability to prioritize multiple tasks and achieve deadlines • Ability to adapt to changing environment • Strong written and verbal skills • Initiative, judgement, exceptional organizational skills and keen attention to detail • Ability to work and process time-sensitive information • Ability to work under normal office conditions and from home as required • Ability to use a telephone/headset and PC/keyboard simultaneously and sit for extended durations • May be required to work additional hours beyond standard work schedule

🏖️ Benefits

• Medical, dental and vision coverage • Retirement plans • Paid time off • Employer-paid life and disability insurance with additional buy-up coverage options • Tuition program • Well-being benefits • Full suite of benefits to support career development, individual & family health, and financial health • Variable pay eligibility