Credentialing Specialist
Lumeris · US
Your Future is our Future At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's wh...
Job description
Your Future is our Future At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. Position: Credentialing Specialist Position Summary: The Credentialing Specialist is responsible for coordinating and executing credentialing and re credentialing activities for contracted providers and Health Delivery Organizations (HDOs) in accordance with health plan requirements, state and federal regulations, and NCQA standards. This role ensures the accuracy, integrity, and completeness of credentialing data, supports Credentialing Committee review, and serves as a key liaison with providers, internal partners, vendors, and clients. Job Description: Key Responsibilities Credentialing Operations: - Monitor ongoing provider compliance, professional license sanctions, and quality indicators. - Maintain a...