Are you passionate about ensuring the highest quality standards for healthcare providers? Do you have a knack for detail and accuracy? If so, we have an exciting opportunity for you to join our team at Highmark Health as a Spec Credentialing I / OPEIU! In this role, you will play a crucial role in the credentialing process for our healthcare network, ensuring that providers meet all necessary qualifications and comply with industry regulations. We are looking for a motivated and detail-oriented individual with a strong background in credentialing and a commitment to delivering exceptional customer service. If you are ready to make a meaningful impact in the healthcare industry, we encourage you to apply for this position.
Conduct initial and ongoing credentialing and re-credentialing of healthcare providers in accordance with industry standards and regulations.
Review and verify provider applications, credentials, and supporting documentation for accuracy and completeness.
Communicate with providers and internal stakeholders to obtain missing or additional information as needed.
Maintain accurate and up-to-date provider data in the credentialing database.
Conduct primary source verification of provider education, training, licensure, and other credentials.
Ensure compliance with all regulatory and accreditation requirements related to provider credentialing.
Monitor and track expiration dates of provider credentials and take necessary actions to maintain compliance.
Identify and escalate any potential issues or discrepancies in provider credentials to management.
Assist with audits and investigations related to provider credentialing.
Collaborate with cross-functional teams to improve processes and enhance the overall quality of credentialing.
Provide exceptional customer service to all internal and external stakeholders regarding credentialing inquiries.
Stay current on industry trends and best practices related to provider credentialing.
Maintain confidentiality and adhere to all HIPAA and privacy regulations.
Participate in training and development opportunities to enhance knowledge and skills.
Other duties as assigned by management.
Highmark Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
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