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D
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managed care credentialing processes, including provider enrollment, medical license verification, and database management. Proficient in maintaining compliance with HIPAA regulations while ensuring accurate and up-to-date provider information.
Highest-signal resume keywords
Managed Care CredentialingProvider EnrollmentMedical TerminologyHIPAA ComplianceProject Coordination
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Credentialing ApplicationsCAQH Profile MaintenanceMedical License VerificationDatabase ManagementOnboarding Process Streamlining
Soft Skills
Attention to DetailProblem SolvingOrganizational SkillsTeam CollaborationInitiative
Certifications & Qualifications
High School Diploma
Industry Keywords
Managed CareMedical OfficeBillingInsuranceProvider Data Management
About the role
Key responsibilities & impact- Support initiatives across the credentialing team
- Assist with provider enrollments
- Maintain CAQH profiles
- Obtain and review physicians’ medical licenses
- Help with hospital privileging
- Complete and process credentialing applications
- Collect provider credentials and update internal and external databases
- Review and streamline onboarding processes and workflows, using automation where appropriate
- Interact with management, physician office staff, and physicians to accomplish credentialing activities
- Maintain up-to-date provider data in credentialing databases and online systems
- Maintain accurate provider rosters for insurance companies
- Track CAQH completion and re-attestation dates
- Track expirables such as medical licenses, DEA, and CDS
- Notify administration, billing, and operations of provider effective dates
- Maintain confidentiality of provider information
- Complete initial hospital and reappointment applications
Requirements
What you’ll need- 0-2 years’ experience in managed care credentialing, billing and/or Medical Staff service setting
- High School Diploma or equivalent
- Previous experience working in a medical office, preferred
- Working knowledge of medical terminology, billing, insurance a plus
- Demonstrated skills in problem solving analysis and resolution
- Attention to detail
- Must comply with HIPAA rules and regulations
- Extremely responsive, detail-oriented, and organized
- Ability to perform a variety of duties within any workday
- Team approach to working with others
- Project coordinating experience
- Demonstrates tenacity and initiative
- Analytical and organized
- Self-starter and independent problem-solver