AS
Provider Credentialing Specialist
Accede Solutions Inc
Location not stated
Remote
2 weeks ago
- CMS
- Regulatory Compliance
2 weeks ago
Not enough detail in this posting to match
Location - 100% Remote
Duration: 05+ months
Shift: M-F 09 AM to 06 PM
Position Summary
The Provider Credentialing Representative is responsible for performing day-to-day credentialing activities to ensure healthcare providers meet all regulatory, payer, and organizational requirements. This position completes credentialing and re-credentialing activities, performs Primary Source Verification (PSV), prepares provider files for committee review, and maintains accurate provider records.
Essential Responsibilities
• Process initial credentialing applications.
• Process re-credentialing applications.
• Perform Primary Source Verification (PSV).
• Review provider applications for accuracy and completeness.
• Request missing documentation from providers.
• Verify licenses, board certifications, DEA, malpractice coverage, education, and work history.
• Maintain accurate provider records within the credentialing system.
• Prepare provider files for committee review.
• Track credentialing deadlines and follow up on outstanding items.
• Communicate with providers regarding credentialing requirements.
• Escalate issues that may delay credentialing completion.
• Ensure compliance with CMS, NCQA, and organizational standards.
• Assist with audits and quality reviews.
• Maintain confidentiality of provider information.
• Meet departmental productivity and quality expectations.
Qualifications
• High school diploma required; Associate's or Bachelor's degree preferred.
• 2+ years of healthcare credentialing experience preferred.
Knowledge of:
o Initial Credentialing
o Re-credentialing
o Primary Source Verification (PSV)
o Healthcare credentialing documentation
• Strong attention to detail.
• Excellent organizational skills.
• Strong verbal and written communication skills.
Core Competencies
• Provider Credentialing
• Primary Source Verification
• Data Accuracy
• Time Management
• Customer Service
• Regulatory Compliance
• Documentation Review
• Organization
• Communication
• Team Collaboration
Provider Credentialing Specialist · Accede Solutions Inc