Credentialing Specialist

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

JOB SUMMARY / PURPOSE

Processing credentialing and recredentialing applications accurately and in a timely manner; review files for application completion in compliance with The Joint Commission standards, NCQA standards and Medicare/Medicaid standards.

ESSENTIAL KEY JOB RESPONSIBILITIES

1. Process primary verification data during the credentialing and recredentialing of providers.
2. Prepare verification letters.
3. Maintain database for provider credentialing and recredentialing.
4. Contact medical office staffs, licensing agencies and insurance carriers to complete credentialing and recredentialing applications.
5. Handle confidential information in an appropriate manner.
6. Support OPPE and FPPE processes.
7. Performs other duties as assigned to meet the organization`s needs.

Licensure and Certifications / Minimum Knowledge, Skills and Abilities

• Education

Required: High school diploma or equivalent (GED)

Preferred: Associate degree or equivalent

• Experience

Required: 2-5 years prior office work experience

Preferred: Five to seven years credentialing experience

• Skills

Required: Microsoft Office proficiency

Preferred: Credentialing experience

• Licensure/Certifications

Preferred: CPCS, within one year of eligibility