Credentialing Specialist (Forest Park) Job at Dunhill Professional Search & Government Solutions, Forest Park, GA

TGJIM2t5aTVFT0tmdisrN2xrU2JZeUxkVEE9PQ==
  • Dunhill Professional Search & Government Solutions
  • Forest Park, GA

Job Description

Job Description

Processes credentialing and re-credentialing applications for the client. Reviews applications and prepares verification letters. Contacts various departments, licensing agencies, and insurance carriers to complete credentialing and re-credentialing applications. Provides support to the client in the collection and query of credentials of members of the client.

  • Conducts Primary Source Verification (PSV) of credentials such as licenses, certifications, registrations, professional school education, postgraduate, residency, or specialty training, board certifications, work history, and current references.
  • Conducts queries through the National Practitioner Data Bank (NPDB), the Defense Practitioner Data Bank (DPDB), the Department of Health and Human Services (DHHS) and TRICARE sanction data banks.
  • Collects professional/peer references and completed clinical privileges, demographics, military and civilian practice history (including adverse privileging actions and malpractice history), health status, documentation of contingency and continuing education training, national provider identification number, and for non-personal services contract providers malpractice insurance information.
  • Accurately loads appropriate data in the DoD Centralized Credentials Quality Assurance System (CCQAS). Keeps records and documentation of the applications and verifications maintained.
  • Establishes and maintains updated CCQAS records.
  • Researches and solves credentialing/re-credentialing problems; escalates more complex issues as appropriate.
  • Tracks status of credentials for healthcare practitioners and provides required documents to clients to make accession, credentialing and privileging (C&P) decisions.
  • Maintains relationships with Military Treatment Facilities and supported customers.
  • Ensures providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities.
  • Reviews records for regulatory compliance and quality assurance at a healthcare facility, insurance group, or similar organization, ensuring relevant regulations are met.

Minimum Qualifications

  • US Citizen with HS diploma or GED; Bachelor's Degree in healthcare or business field preferred
  • Certified Provider Credentialing Specialist (CPCS) preferred
  • 2-5 years of experience performing physician credentialing at a medical group, hospital or health plan.
  • Must be able to Pass a government background check

Other Job Specific Skills

  • Strong customer focus, interpersonal, collaboration, written/verbal communication, prioritization and computer skills.
  • Strong attention to detail and good organizational capability.
  • Able to handle multiple simultaneous tasks and complete work projects in designed time frames.
  • Knowledge of Department of Defense credentialing guidelines preferred.
  • Experience using Centralized Credentials Quality Assurance System (CCQAS) and Defense Medical Human Resources System - internet (DMHRSi) a plus.
  • Ability to handle confidential information on a daily basis in a professional manner.
  • Ability to consistently maintain quality and production expectations.
  • Possess proof-reading skills sufficient for auditing documents.
  • Demonstrate familiarity with credentialing policies, guidelines, and regulations for the DoD credentialing process.

Job Tags

Contract work, Part time,

Similar Jobs

Great Wolf Lodge

Attractions Attendant Job at Great Wolf Lodge

Pay: $16.25 per hour At Great Wolf, the Attractions Attendant may work in any number of Attractions at Great Wolf Lodge, including but not limited to the Arcade, Ropes Course, MagiQuest, Moonstone Mine sluice, Bowling, Rock Wall other attractions within the Family Entertainment...

Essentia Health

PHYSICIAN - Otolaryngology - Fargo, ND Job at Essentia Health

 ...Education Qualifications: Licensure/Certification Qualifications: Otolaryngology Fargo, ND Essentia Health Fargo, North Dakota. Opportunity for an Otolaryngologist to join an established, and growing team within a stable, clinician-led, organization... 

Home Depot

Traveling In-Home Measure Specialist Job at Home Depot

A leading home improvement retailer is looking for a Measure Technician (In-Home Advisor) to work independently in various locations....  ...transportation, with 1+ years of relevant experience preferred. This role offers a salary range of $18 - $23 per hour.#J-18808-Ljbffr Home Depot

Paycom Payroll Llc

Client Success Manager Job at Paycom Payroll Llc

Job Description This position is not eligible for sponsorship and Paycom is unable to support an optional or curricular practical training (OPT/CPT) program. Paycom is interested in every qualified candidate who is eligible to work in the United States. Why Join ...

Way Solutions

Software Engineering Intern Job at Way Solutions

 ...join: Airbnb is excited to welcome Software Engineering Interns for our2026 Summer Intern Program . At Airbnb, our Engineering team...  ...graduation: December 2026June 2027). Familiarity with computer science fundamentals (data structures, algorithms, design patterns...