QualDerm Partners
Hospital & Health Care
CredentialingSpecialist
Neural analysis suggests this role is
optimal for Mid candidates.
“Credentialing Specialist at QualDerm Partners. Skills: Credentialing, Payer Enrollment, Process Management. Oversee all aspects of Provider Credentialing and Payer Enrollment. Assure compliance with all health plan requirements”
What You'll Achieve.
Ensure proactive communication on credentialing and recredentialing requirements; Ensure that credentialing is complete in advance of services being rendered
Industry & Context.
Demonstrated skills in analysis, problem solving and resolution
What They're Looking For.
Must Have
Minimum of three (3) years’ experience in managed care credentialing or medical staff service setting required, Demonstrated skills in analysis, problem solving and resolution, Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information, knowledge of NCQA, Joint Commission, URAC, CMS and State Laws and regulations as they pertain to the credentialing of QualDerm providers, Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements, Must be able to function independently in a matrix environment
Nice to Have
Bachelor’s degree in related field preferred, National or multi-state credentialing experience preferred
What You'll Do.
Oversee all aspects of Provider Credentialing and Payer Enrollment
Assure compliance with all health plan requirements
Meet with assigned region operational leadership
Manages processes that maintain up-to-date data
Ensures timely renewal of licenses
Maintains confidentiality of provider information
Assist in managing the flow of information
Coordinate and prepare management reports
Manage continual process and quality improvement efforts
Participates in the training of new team members
How You'll Work.
Team & Collaboration
Develop relationships with regional operational leaders; Work with regional operational leaders to ensure timely on-boarding; Assist in managing the flow of information between payers, contracted PHO’s, ACO’s and other QualDerm networks
Communication Scope
Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information
Full Job Description
With 150+ locations in 17 states, QualDerm Partners is the largest multi-state female-founded and owned dermatology network in the U.S. At QualDerm Partners, we are united in our purpose: to educate, protect, and care for your skin. We are committed to bringing you the very best in comprehensive skin care so that you can achieve a confident, healthier, and more beautiful you! Our mission is to educate communities and healthcare professionals about the importance of skin health; including skin cancer prevention, risk factors and how to achieve healthy skin through annual skin exams and dermatologic care. We strive to provide the latest proven, proactive and comprehensive dermatologic care to populations in the expanding geographies we serve by making high-quality skin care timelier and more accessible all while creating a rewarding work environment for our providers and employees. **Purpose:** Reporting to the Senior Director, Credentialing and Revenue Cycle, the Credentialing Specialist is responsible for overseeing all aspects of the credentialing, re-credentialing, payer enrollment and privileging processes for all providers in an assigned region. The Credentialing Specialist will develop strong relationships with regional operational leaders to ensure proactive communication on credentialing and recredentialing requirements while ensuring that credentialing is complete in advance of services being rendered under contracted and enrolled health plans. The Credentialing Specialist will be responsible for implementing standardized processes and capturing data for each provider in QualDerm's credentialing databases and online systems for utilization across multiple stakeholder groups. **Essential Duties and Responsibilities:** * Oversee all aspects of Provider Credentialing and Payer Enrollment with third party payers and hospital / health system partners for assigned region. * Assure compliance with all health plan requirements as related to provider certification an
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