Credentialing Specialist

Point32Health is hiring a Credentialing Specialist to ensure affiliated physicians, independent practitioners, and allied providers are qualified to provide healthcare services under applicable policies, laws, and regulatory requirements. The role processes and verifies credentialing information, supports practitioners through the credentialing process, and prepares files for compliance and medical director review.

Responsibilities

• Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them, and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment. Requires the ability to learn and apply Point32Health policies consistently and seek out guidance when necessary
• Responsible for maintaining and processing physician and provider credentialing information for new and established health plan practitioners in accordance with Point32Health’s policies and procedures, state laws and regulatory agencies, including but not limited to:
• Assessment of adequate and accurate information for participation in Point32Health, including a limited knowledge of provider contract information
• Accurate and timely entry of initial and existing credentialing applications into the credentialing information system (Cactus)
• Verification through various sources of necessary licenses, board certification, etc
• Review and report of adverse information received through National Practitioner Data Bank (NPDB), state and federal sanctions
• Retrieval of missing and/or expired information/documentation required for credentialing
• Act as resource for physician and provider questions relating to certification and/or credentialing process
• Identify for Credentialing Supervisor those issues of broader complexity or sensitivity that may require further action by a Medical Director or other outside source
• Daily, prepare files that Meet Credentialing Criteria for review by the Credentialing Compliance Coordinator and/or Supervisor and presentation to daily Medical Director file review
• Prepare files that may not Meet Credentialing Criteria for review by the Medical Directors and/or Senior Credentialing Specialist and/or Supervisor and presentation to the Quality-of-Care Committee (QOCC), including report of adverse information
• Daily, process all practitioners under the terms and conditions of the entities’ agreement, including files credentialed through a Certified Verification Organization (CVO)
• Participate in task forces and/or other meetings as assigned and execute other responsibilities as assigned
• Other duties and projects as assigned

Preferred

• Preferred: Bachelor's degree
• Preferred: Experience with provider credentialing
• Knowledge Word and Excel
• Bachelor’s Degree
• Provider Credentialing
• Microsoft Word
• Microsoft Excel

Benefits

• Colleagues are also eligible for variable pay.
• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health
• Work from home as required

Company

• Not-for-profit health and well-being company
• Canton, Massachusetts, USA
• https://www.point32health.org/
• Founded in 2021
• 1001-5000 employees

Qualifications

• Required (minimum): High school diploma
• Required (minimum): 1-2 years of experience in healthcare field
• Experience with personal computer
• All information (written, verbal, electronic, etc.)
• Ability to appropriately identify emergency situations and follow the appropriate protocol
• Must have the ability to maintain and manipulate a complex credentialing information system
• Must be able to prioritize multiple tasks and achieve deadlines
• Must have ability to adapt to changing environment
• Strong written and verbal skills are necessary
• Individual must possess initiative, judgement, exceptional organizational skills and keen attention to detail
• Must be able to work and process time-sensitive information
• Preferred: Bachelor's degree
• Preferred: Experience with provider credentialing
• Knowledge Word and Excel
• Required (minimum): 1-2 years of experience in healthcare field.

Required skills

• Healthcare, Provider Credentialing, Microsoft Word, Microsoft Excel

Preferred skills

• Preferred: Bachelor's degree, Preferred: Experience with provider credentialing, Knowledge Word and Excel

Experience

• 1-2 years