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Credentialing Specialist
Detroit Wayne Integrated Health NetworkCredentialing Specialist responsible for reviewing provider applications and maintaining accreditation standards. Ensures compliance with federal and state regulations for DWIHN healthcare professionals.
About the role
Key responsibilities & impact- Completes review of provider credentialing and re-credentialing applications checking for completeness and accuracy.
- Prepares reports for the Credentialing Committee on provider file status.
- Completes National Practitioner Database Check, Systems for Award Management database check, MDHHS Sanctioned Providers List, and OIG checks as appropriate.
- Maintains, tracks and monitors the expiration dates of SAM Registration, accreditation, and license expiration and notifies providers as needed.
- Manages the Credentialing process using the Medversant system.
- Serves as the primary contact for the Managed Care Operations unit for Medversant and other Credentialing provider inquiries.
- Provides instruction and training to the DWIHN Provider Network on the Credentialing process.
- Responds to all Provider Requests for new applications and questions regarding the Credentialing process.
- Provide status updates for providers and practitioners.
- Assists in updating policies and procedures for the Credentialing process.
- Completes Readiness Reviews of Providers upon request.
- Maintains database of approved services to determine the capacity of the Provider Network.
- Prepares and sends approval letters to providers.
- Collects and processes verification and accreditation information.
- Updates and maintains accurate databases for facilities and practitioners.
- Attends Credentialing Committee, subcommittee and other meetings.
- Maintains confidentiality of all Provider/ practitioner information.
- Performs related duties as assigned.
Requirements
What you’ll need- A High School Diploma, a GED or its equivalent.
- Four (4) years of full-time paid professional experience performing administrative duties and responsibilities.
- One (1) year of full-time paid professional experience performing credentialing and impaneling duties and responsibilities.
- A valid State of Michigan Driver’s License with a safe and acceptable driving record.
- Certified Provider Credentialing Specialist (CPCS) certification is preferred, not required.
Benefits
Comp & perks- Health insurance
- Remote work options
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
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Hard Skills & Tools
Credentialing Application ReviewNational Practitioner Database CheckOIG ChecksAccreditation ManagementVerification Processing
Soft Skills
CommunicationTrainingConfidentiality Maintenance
Certifications
Certified Provider Credentialing Specialist (CPCS)