Credentialing Specialist - Mechanicsburg, PA

Credentialing Specialist

Zetter HealthCare
Mechanicsburg, PA

Applicants only.  No agencies, please.

JOB TITLE:                        Credentialing Specialist
REPORTS TO:                  Senior Consultant
FLSA STATUS:                  Non-exempt or Exempt
JOB OVERVIEW:              Responsible for all aspects of the credentialing, recredentialing and privileging process for all Zetter HealthCare client providers.  Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities as directed.  Maintain up-to-date data and documents in CAQH, NPPES, PECOS for each provider in credentialing databases and online systems, ensure timely receipt and submission of all licenses and certifications.
 
ESSENTIAL FUNCTIONS INCLUDE, BUT ARE NOT LIMITED TO:
 
1.      Compiles and maintains current and accurate data for all providers.
2.      Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed to obtain information from providers, clients or other contacts.
3.      Maintains copies of current state licensure, DEA/CDS certificates, malpractice coverage and cases, and any other required credentialing documents for all client providers.
4.      Maintains corporate provider contract files.
5.      Maintains knowledge of current health plan and agency requirements for credentialing providers.
6.      Sets up and maintains provider information in online credentialing databases and system.
7.      Tracks license, certification and malpractice expirations for all providers to ensure timely renewals.
8.      Ensures practice addresses are current with health plans, agencies and other entities.
9.      Processes applications for appointment and reappointment of privileges with hospitals and facilities as applicable.
10.    Maintains appointment files and information in credentialing database.
11.    Performs other duties as delegated.

ADDITIONAL RESPONSIBILITIES:
 
1.      Maintains confidentiality of provider information.
2.      Provides credentialing and privileging verifications
3.      Performs other duties as assigned.
 
QUALIFICATIONS:
 
Education:
1.      High school diploma or equivalent.
2.      Associate degree preferred.
 
Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.
 
Experience: Two years of relevant medical credentialing experience.REQUIRED
 
COMPENSATION & BENEFITS:
  • Wages commensurate with work experience
  • Health insurance available based on current benefit package
  • Paid Time Off
  • Continuing education
  • Corporated paid malpractice
  • Safe Harbor 401k retirement plan after 1 year

Applicants only.  No agencies, please.

Qualified individuals may submit their resume to:
Zetter HealthCare,  Attn: David J. Zetter at This email address is being protected from spambots. You need JavaScript enabled to view it. or by fax to (717) 691-6855