Credentialing Specialist

MJ Morgan Group - Sparks Glencoe, MD

Currently seeking a Credentialing Specialist in Sparks Glencoe, MD. The ideal candidate will oversee the managed care credentialing process for portable radiology and bedside laboratory units. This individual will also be responsible for submitting and maintaining accurate records and up to date licensing information for physicians/sites.

Credentialing Specialist Responsibilities

  • Create and maintain business unit and physician application.
  • Maintain all master files relating managed care credentialing guidelines.
  • Develop and maintain managed care credentialing contacts.
  • Work with various internal departments to resolve credentialing issues.
  • Ensure provider credentialing applications are complete, accompanied with the appropriate requested documentation, and returned within 48 hours of receipt.
  • Enter updated license(s) and certification(s) into the managed care shared drive.
  • Coordinate, prepare, track and facilitate the new enrollment and maintenance of business units and physicians.
  • Review requests for ownership information.
  • Research and solve credentialing/re-credentialing delays & issues with enrollment.
  • Provide submission of enrollment applications, processes all re-enrollment expirees management and CAQH re-attestations.
  • Ensure all submissions are noted and credentialing packet documents have been scanned and attached to the business units shared drive record.

Credentialing Specialist Requirements

  • 3-5 Years of credentialing experience in an ancillary healthcare setting (managed care setting preferred)
  • Associate degree or equivalent and two years’ work-related experience, Bachelor's degree preferred
  • CPCS (Certified Provider Credentialing Specialist) preferred but not required
  • One App experience preferred

Posted On: Friday, March 8, 2019

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