Job Description
Job Description
Job Description
REMOTE - MUST BE LOCAL TO ORLANDO, FLThe Credentialing Specialist reports to the Network Operations Manager and is responsible for activities associated with credentialing or re-credentialing of network providers, including review of providers credentialing documentation, processing, loading providers into the tracking database system to ensure high quality standard are maintained.
salary: $20 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: Associate
Responsibilities
- Collect and evaluate initial and re-credentialing applications from providers and submit them to credentialing specialists.
- Support NCQA audits and ensure compliance with credentialing QA standards.
- Review provider documentation for re-credentialing and report any issues to leadership.
- Monitor credentialing cycles to ensure compliance with regulatory and accrediting agency standards.
- Maintain communication with provider representatives regarding the credentialing status of their providers.
- Follow up on non-compliant physicians and facilities, recommending corrective actions when necessary.
- Prepare end-of-month reports to communicate credentialing committee outcomes to providers.
- Assist with mailing credentialing applications and follow-ups as per policy timelines.
- Handle incoming calls, prepare provider mail-outs, and manage special projects.
- Maintain and file provider records, ensuring compliance with inventory procedures.
- Set up and manage practitioner files, contracts, and key documents in the credentialing workflow.
- Prepare provider grids and profiles for credentialing committee review.
- Support meeting coordination, including managing deadlines, agendas, and compiling meeting materials.
- Assist with meeting minutes, follow-up items, and documentation within one week of meetings.
- Conduct follow-up activities after credentialing meetings, including notifying teams, sending welcome letters, and re-credentialing confirmations
Skills
- Microsoft Office
- Credentialing
- NCQA
- Report Preparation
- Compliance
- Communication
- Health Insurance Policies
- Administrative Duties
Qualifications - Years of experience: 5 years
- Experience level: Experienced
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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status. At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com. Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility). This posting is open for thirty (30) days.
Job Tags
Hourly pay, Permanent employment, Temporary work, Work experience placement, Local area, Shift work,