Physician Credentialing Specialist at Managed Care Staffers

Experienced Temporary F/T Physician Credentialing Specialist West Loop of Chicago

Our client, a busy nephrology business office located in the West Loop of Chicago has an immediate staffing need for an experienced temporary full-time Credentialing Specialist. You must have at least 2 years of recent credentialing experience. You will be responsible for the physician credentialing and coordinating the credentialing process, which includes gathering all credentialing materials, maintaining and updating records and documentation, reaching out to health plans for follow-up and problem resolution and ensuring ongoing compliance as required by the regulatory agencies. 

Daily Responsibilities:

Physician credentialing, coordinating the process of gathering all credentialing materials as mandated by NCQA and Health Plans.  Maintaining an up-to-date physician database.  Monitoring & conducting follow-ups regarding supportive credentialing documentation including licensure, malpractice status and history, board certification, medical staff dues, etc. Resolves issues with payers, patients, plans and providers and responds to both written and verbal inquiries for miscellaneous information

Knowledge Skills and Abilities:

Working knowledge & understanding of the medical insurance industry and health plans.  Above average computer navigation skills, with basic/advanced Microsoft Office/Outlook, Excel and intra/internet experience.  Ability to comprehend departmental NCQA, Payer and policies and procedures related to credentialing.  Familiar with physician credentialing for the State of Illinois, Medicare, Medicaid and all forms associated with this application process. Skills in gathering, analyzing and evaluating data in order to provide input to decisions. A significant level of communication and interpersonal skills.

Educational Requirements:

A High School Diploma is required a college degree is preferred.

Certification as a Certified Provider Credentialing Specialist (CPCS) and/or Certified Medical Staff Coordinator (CMSC) preferred. 

Candidate must have a strong knowledge of the NCQA Qualifications, State of Illinois Application Process, Medicaid, Medicare and all of the other forms of applications.

If you or anyone you know is interested, qualified and immediately available please send an updated resume to us for immediate review and consideration.