Credentialing Specialist

• Maintain and process physician and provider credentialing information for new and established health plan practitioners
• Assess adequate and accurate participation information, including provider contract information
• Enter initial and existing credentialing applications into the Cactus credentialing information system
• Verify licenses, board certification, and other required credentials through various sources
• Review and report adverse information from the National Practitioner Data Bank and state/federal sanctions
• Retrieve missing or expired information and documentation required for credentialing
• Serve as a resource for physician and provider questions about certification and credentialing
• Identify complex or sensitive issues for the Credentialing Supervisor and potential review by a Medical Director or outside source
• Prepare files meeting credentialing criteria for Credentialing Compliance Coordinator/Supervisor review and Medical Director file review
• Prepare files not meeting criteria for Medical Director, Senior Credentialing Specialist, or Supervisor review and Quality-of-Care Committee presentation
• Process practitioners under entity agreement terms, including files credentialed through a Certified Verification Organization
• Participate in assigned task forces and meetings
• Perform other assigned duties and projects

Explore Credentialing Specialist at Point32Health. Review requirements and application details.