Purpose & Scope:
The Senior Credentialing Specialist for Managed Care acts as the lead within the Credentialing Specialist team, supporting complex and high-volume credentialing and enrollment processes for physicians and advanced practice providers within insurance plans. The role involves coordinating team efforts, facilitating credentialing tasks with government and commercial payers to expedite effective dates of insurance participation for new and existing providers. Ensures data integrity in various systems for successful re-credentialing and compliance.
Education:
Bachelor's degree in a healthcare related field is preferred.
Experience:
At least two years of insurance plan credentialing experience in a physician practice, hospital, or managed care setting, with demonstrated ability to lead projects or small teams.
Certification/Licensure:
Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) is preferred.