Position Summary
The Credentialing Specialist is responsible for coordinating and implementing all activities related to the credentialing and privileging of Revere Health providers. This includes maintaining accurate provider data, facilitating initial and re-credentialing processes, conducting primary source verification, and supporting providers in maintaining licenses, certifications, and other required credentials.
Essential Job Functions
- Supports onboarding processes for incoming providers.
- Conducts, participates in, and maintains initial and re-credentialing processes.
- Analyzes applications and supporting documentation, identifying any missing or incomplete information.
- Processes privilege requests and maintains privileging documentation.
- Obtains and evaluates information from primary sources.
- Verifies expirables and ensures compliance with accreditation and regulatory standards.
- Responds to external verification inquiries.
- Maintains accurate, current provider records and databases.
- Ensures compliance with NCQA, CMS, URAC, and organizational requirements.
- Tracks and assists in renewal of state licenses, DEA, malpractice coverage, and other required credentials.
Qualifications
- Excellent interpersonal, verbal, and written communication skills.
- Strong organizational skills with the ability to manage multiple tasks and deadlines.
- High attention to detail with a commitment to accuracy and data integrity.
- Proficiency with computers, databases, and credentialing platforms.
- Ability to work diplomatically with providers, administrators, and external partners.
- Demonstrates professionalism, sound judgment, and a positive presence.
- Applies problem-solving skills to analyze data, identify trends, and resolve discrepancies.
- Organizes work, sets priorities, and aligns processes to achieve department goals.
- Experience as professional support in medical field or medical staff services preferred