Credentialing Specialist 1 - 111453

• Verify and maintain all network, individual, facility, and ancillary provider information.
  
• Monitor disciplinary actions and follow up accordingly.
  
• Correspond with licensing boards, hospitals, certification agencies, training programs, and medical groups to resolve credentialing issues.
  
• Ensure and maintain overall accuracy of the credentialing database.
  
• Gather data, build/run reports, and send updates as required.
  
• Communicate with practitioners, office staff, provider network administrators, contracting, and management to resolve credentialing issues.
  
• Review and identify credentialing or re-credentialing practitioners, including verification of correspondence and data entry, in accordance with company policies and procedures.
  
• Review and analyze reports, policies, and procedures; summarize findings, make notations, and provide feedback for distribution to management and the Credentialing Committee.
  
• Assist in preparing file reports and binders for monthly Credentialing Committee meetings, including pre- and post-Committee functions.
  
• Support internal projects to obtain follow-up information as requested by the Credentialing Committee or Peer Review Teams.
  
• Perform other duties as assigned.
  

• High school diploma required.
  
• Associate's degree in Business Administration, Healthcare Administration, or related field preferred.
  
• 0-2 years of related experience.
  

• Associate's degree, or high school diploma/equivalent with 1+ years of experience in data entry, customer service, medical office, provider data management, credentialing, or healthcare operations (claims processing, billing, provider relations, or contracting), preferably in a managed care or insurance environment.
  

• Perform credentialing and re-credentialing activities in compliance with plan specifications and NCQA standards.
  
• Professionally communicate with physicians, office managers, providers, and other third parties to obtain required information.
  
• Gather information for Credentialing Committee meetings.
  
• Process, track, and file credentialing applications within established standards.
  
• Generate and utilize reports to support business functions.
  
• Thrive in a fast-paced production environment while maintaining high quality standards.
  

• Health plan or business unit focus.
  
• Team culture centered on collaboration and accountability.
  
• Team structure: 11 credentialers, one manager, and one supervisor.
  
• Purpose: Vet online credentialing requests from contracted groups statewide, gather documentation, and process requests through the internal system.
  
• Reason: To maintain timeliness and accuracy in credentialing to avoid provider abrasion and member impact.
  
• Motivation: Achieve and maintain a 45-day turnaround time for adding new practitioners.
  

• Review and process online webform submissions assigned via a shared mailbox.
  
• Create practitioner folders in the S Drive, gather documentation, and save records.
  
• Submit completed requests through the internal system and communicate status to providers.
  
• Track missing information in SharePoint.
  
• Collaborate with team members through chat for real-time support.
  
• Training phase: no overtime. Once independent, candidates must meet the weekly metric of 75 completed requests during an 8-hour shift to qualify for overtime.
  
• Standard schedule: 8:00 AM - 4:30 PM (flexible during the day).
  

• Requests vary across provider specialties, with current high demand in Behavioral Health.
  
• Key initiative: Stay current with practitioner add requests to avoid AHCA complaints or member disruption.
  
• Quality standards: Maintain a minimum quality score of 95%, increasing to 99% after the team adapts to audits.
  
• Value: Gain experience in provider credentialing, managed care operations, and healthcare compliance.
  

• Associate's degree, or high school diploma/equivalent with 1+ years of relevant experience.
  

• None required.
  
• Preferred: NAMSS Credentialing Certification, knowledge of NCQA standards.
  

• 1+ years in data entry, customer service, medical office, provider data management, credentialing, or healthcare operations.
  

• Ability to work under pressure.
  
• Strong time management skills.
  
• Excellent communication skills.
  

• NAMSS Credentialing Certification.
  
• Familiarity with NCQA standards.
  

• Inability to follow established processes.
  
• Failure to meet productivity or quality metrics.
  

• Attendance, timeliness, adaptability, quality, and ability to meet metrics.
  

• Best: Meets productivity metrics consistently without sacrificing quality.
  
• Average: Completes assigned tasks but requires additional guidance to meet performance goals.
  

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 244432 when responding to this ad.