You can be the one who makes a difference for millions of members. Our organization is transforming the health of our communities, one person at a time. As a diversified, national healthcare leader, we provide access to competitive benefits and a fresh perspective on workplace flexibility.
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In this role, you will assist the health plan in the meticulous process of credentialing and re-credentialing healthcare providers. You will ensure that every physician, facility, and pharmacy in our network meets the highest standards of safety and professional excellence.
Responsibilities:
Credentialing & Re-credentialing: Perform primary source verification and process applications for various providers (physicians, facilities, and ancillary providers) according to plan specifications and NCQA standards.
Data Management: Maintain and update the provider credentialing database to ensure all information is current, accurate, and audit-ready.
Committee Support: Gather and prepare necessary documentation for Credentialing Committee meetings and assist in the coordination of these sessions.
Compliance: Monitor expiring licenses, DEA certifications, and malpractice insurance, proactively initiating the renewal process to prevent disruptions in service.
Inquiry Resolution: Act as a point of contact for internal and external customers regarding credentialing status, providing professional and timely responses.
Reporting: Generate and utilize reports to track application progress and support business functions within a fast-paced production environment.
Working hours: 8:00 AM - 5:00 PM
Skills:
Advanced Software: Experience with credentialing systems like Cactus, Echo, or Visual CACTUS.
Professional Certification: CPCS (Certified Provider Credentialing Specialist) or CPMSM designation.
Audit Experience: Prior experience preparing files for state or federal audits.
Risk Management: Ability to identify "red flags" in provider work histories or malpractice logs.
Education:
Masters
Experience:
1-4 years
Qualifications:
Credentialing Expertise: 1???2+ years of experience in healthcare credentialing, provider data, or medical billing/claims.
Regulatory Knowledge: Solid understanding of NCQA or CMS credentialing standards.
Verification Skills: Experience performing Primary Source Verification (PSV) via NPDB, OIG, and state boards.
Technical Tools: Proficiency in Microsoft Excel (data tracking) and the CAQH portal.
Accuracy: High-speed data entry with a "first-time right" mindset to prevent claims denials.
If you have the experience and are interested Apply today
Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.
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 Spherion, 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 Callcenter@spherion.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, Spherion offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).