Credentialing Specialist

Job description

Develop and cultivate productive relationships with providers, retail chains, strategic partners, and their staff. Elevate providers’ understanding of industry standard credentialing requirements, leveraging team knowledge and resources. Establish relationships with providers to obtain required regulatory information and manage all aspects of the providers’ initial and ongoing credentialing requirements Use independent judgment to ensure that documentation complies with appropriate state regulations Oversee and manage assigned files in the CVO partner’s system Track in-progress credentialing files, identify and collect missing documents to ensure timely completion of the credentialing process for new and existing providers, and ensure that state regulatory standards are met Research, analyze, and resolve complex credentialing issues and escalations, coordinating with internal and external business partners when needed, in order to meet compliance requirements Use analytical and investigative skills to collect, evaluate, and compile information from regulatory reporting agencies, legal documents, and the provider to support the explanation of provider sanctions and/or malpractice cl...