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NeighborHealth CenterCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider credentialing processes, including primary source verification and compliance with accreditation standards. Proficient in managing confidential information and maintaining accurate credentialing databases while ensuring timely communication with providers and health plans.
Highest-signal resume keywords
Provider Credentialing ExperiencePrimary Source VerificationCAQH Credentialing Database ManagementMedical Credentialing ProcessesClear Verbal And Written Communication
About the role
Key responsibilities & impact- Credential and recredential NeighborHealth Center providers
- Ensure provider enrollment with participating client health plans
- Process credentialing applications and malpractice insurance applications
- Perform primary source verification
- Update and maintain the CAQH credentialing database according to internal policies, client health plan contracts, HRSA guidelines, and state and federal requirements
- Initiate and support provider application processes by sending, receiving, and analyzing provider documents and imported data for completeness
- Gather, verify, and evaluate confidential provider credentials according to departmental guidelines and accreditation standards
- Perform initial credentialing and recredentialing verification and ensure timely handoff or review and approval of provider files
- Respond promptly to provider, client health plan, and internal inquiries
- Monitor expiring licenses, board certifications, professional certifications, and other expirable documents
- Maintain provider paper and electronic files and submit provider data through CAQH
- Perform accurate data entry in credentialing databases
- Collaborate with HR to facilitate smooth handoff during credentialing
- Follow up with providers and internal and external entities to resolve discrepancies
- Monitor compliance and immediately alert HR of undisclosed negative findings
- Review, process, and distribute incoming correspondence, including mail, faxes, and email
- Keep HR and Billing Manager informed of potential credentialing or enrollment issues
- Perform other duties as assigned
Requirements
What you’ll need- Computer literacy in internet use and Windows environment, including Outlook, Word, and Excel
- Ability to cultivate and develop inclusive and equitable working relationships with co-workers and community members
- Ability to serve as an advocate for individuals of all ethnicities, genders, ages, and backgrounds
- Clear and concise verbal and written communication skills
- Ability to work well under tight deadlines and respond to rapidly changing demands with efficient follow-up
- Ability to handle sensitive and confidential information with discretion and trust
- Ability to work Monday through Friday during routine business hours
- Scheduled onsite presence required no less than once a week
- Private home workspace required when working remotely, with screens and conversations protected from others
- Secure, password-protected home internet connection; shared or public Wi-Fi is not acceptable
- Ability to read, write, speak, and comprehend English fluently
- Minimum of 3 years’ experience in provider credentialing in a managed care setting
- Experience with medical and professional credentialing processes, policies and procedures, and delegated credentialing requirements
- Associate degree is preferred or an equivalent combination of education and/or experience
- Ability to sit or stand, often for prolonged periods
Benefits
Comp & perks- Full-time, non-exempt position
- Hybrid work arrangement with scheduled onsite presence no less than once a week
- Equal Opportunity Employer committed to serving a diverse patient population and building a staff reflective of the communities served
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 Applications ProcessingData Entry In Credentialing DatabasesMalpractice Insurance Applications ProcessingMonitoring Expiring LicensesAccreditation Standards Compliance
Soft Skills
Inclusive Working RelationshipsAdvocacy For Diverse IndividualsAbility To Work Under Tight DeadlinesDiscretion And Trust HandlingEfficient Follow-Up
Tools & Technologies
Windows EnvironmentOutlookWordExcelCAQH
Industry Keywords
Managed Care SettingCredentialing Policies And ProceduresDelegated Credentialing RequirementsConfidential Information ManagementHRSA Guidelines