Contact Us 877.823.3669

Credentialing Specialist in Washington, DC at Staffing Now

Date Posted: 3/12/2018

Job Snapshot

Job Description


  • Responsible for implementation and oversight of all activities related to physician credentialing and re-credentialing.
  • Responsible for managing compliance requirements for delegation agreements.
  • Responsible for the development of Credentialing policies and procedures.
  • Maintains knowledge of HRSA, NCQA, and Joint Commission credentialing requirements.
  • Coordinates and manages the dissemination to health plans and other payers.
  • Reviews and analyzes provider file changes.
  • Works with Managed Care and Hospital credentialing coordinators
  • Responds to provider inquiries received by letter, phone, or internal departments.
  • Administers Re-credentialing of network providers.
  • Reviews and monitors provider complaint and grievance files.
  • Provides oversight of managed care or other payer contracts.
  • Administrative Meeting issues as required. Credentialing Committee, Medical Leadership Meetings and to assist with others as needed.
  • Ability to apply common sense understanding to carry out moderately-complex, multi-step instructions and make appropriate independent decisions as necessary
  • Maintains close contact with Billing Department to provide updates on new hires, terminations, approvals from MCOs, and any other information billing department could need from credentialing.
  • Serves as liaison between Medical Directors Staff, Insurance companies, Providers, and Human Resources to ensure provider licenses and provider agreements are current
  • Maintains and updating the providers CAQH files
  • Maintains and updating the providers eClincialWorks profiles

Responsible for assisting with access to various insurance verification. This is an immediate need. Applicantes must possess strong background in credentialing. 5-7 years experience in hospital, managed care or large physican's practice. Please forward a copy of your resume with cover letter.