Are you a Credentialing Specialist who is familiar with basic medical and legal terminology? Are you a Credentialing Specialist who is looking for a direct hire opportunity with a company that offers great benefits?
Our client is a newer company in the Madison area who is passionate about helping and giving back to the community.
WHAT YOU WILL BE DOING:
As a Credentialing Specialist, you will review credentialing applications and follow up with providers as necessary to obtain required information or documentation as well as manage the re-credentialing process.
- Enter and/or update provider demographic, practice and credentialing data and documents in the database as well as accurately document credentialing approval/denial decisions
- Perform primary source verification of provider credentials in accordance with the quality assurance standards
- Identify, investigate and validate discrepancies and adverse information related to providers’ credentials, professional conduct or competence as obtained from provider applications, primary source verifications or other sources
- Perform ongoing monitoring and investigation of professional sanctions, member complaints and quality of care concerns regarding participating providers
- Prepare and present completed credentialing information and recommend appropriate action based on the circumstances of a provider’s application, regulatory requirements and plan policies
- Participate in fair hearings as subject matter expert
- Collaborate with internal staff to ensure plan credentialing requirements are met as well as respond to provider and internal staff inquiries
- Assist with administrative and clerical support as well as help out wherever else needed
WHAT YOU NEED:
- 3-5 years of provider credentialing experience in either a hospital, health system or managed care environment
- Must have knowledge of basic medical and legal terminology
- Must have knowledge of industry-standard credentialing practices and state and federal government credentialing requirements
- Familiarity with the provider community in Wisconsin and the surrounding states is a plus
- An Associate degree in Business, Communication, Legal Studies, Health Care Administration or a related field is a plus
- Computer savvy with the ability to learn new programs quickly
- Basic skillset in MSWD, Outlook and Excel
- Any intermediate knowledge of Excel is a plus
- Ability to preserve and maintain the highest degree of confidentiality
- Excellent organizational skills, high attention to detail and accuracy
- Must be able to remain composed and adaptive in a dynamic, fast-paced, customer-focused work environment characterized by rapid change, minimal lead times and multiple competing priorities
- Strong verbal/written communication skills
- Excellent decision making skills
- Ability to work independently and with minimal supervision but also be able to work within a team environment
Hours: 40 hours between 7:30am – 5:00pm
Length: Direct Hire
Pay for the Credentialing Specialist position: Based on experience, contact us for details
Location: Madison, WI
Job I.D. 136104
WHAT YOU GET:
- Union environment
- Benefits effective first day of employment
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- Disability insurance
- Flex spending
- Paid vacation
- Paid holidays
- Paid maternity leave
- Employee assistance programs
Job descriptions may not include every responsibility or qualification of the position.
Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individuals with Disabilities.
To learn more about Cadre and to view hundreds of immediate openings, please visit our website at www.cadreservices.com.