Credentialing Specialist 136104

Our client is a newer company in the Madison area who is passionate about helping and giving back to the community.

As a Credentialing Specialist, you will review credentialing applications and follow up with providers as necessary to obtain required information or documentation as well as manage the re-credentialing process.

·        Enter and/or update provider demographic, practice and credentialing data and documents in the database as well as accurately document credentialing approval/denial decisions

·        Perform primary source verification of provider credentials in accordance with the quality assurance standards

·        Identify, investigate and validate discrepancies and adverse information related to providers' credentials, professional conduct or competence as obtained from provider applications, primary source verifications or other sources

·        Perform ongoing monitoring and investigation of professional sanctions, member complaints and quality of care concerns regarding participating providers

·        Prepare and present completed credentialing information and recommend appropriate action based on the circumstances of a provider's application, regulatory requirements and plan policies

·        Participate in fair hearings as subject matter expert

·        Collaborate with internal staff to ensure plan credentialing requirements are met as well as respond to provider and internal staff inquiries

·        Assist with administrative and clerical support as well as help out wherever else needed

·        3-5 years of provider credentialing experience in either a hospital, health system or managed care environment

·        Must have knowledge of basic medical and legal terminology

·        Must have knowledge of industry-standard credentialing practices and state and federal government credentialing requirements

·        Familiarity with the provider community in Wisconsin and the surrounding states is a plus

·        An Associate degree in Business, Communication, Legal Studies, Health Care Administration or a related field is a plus

·        Computer savvy with the ability to learn new programs quickly

·        Basic skillset in MSWD, Outlook and Excel

·        Any intermediate knowledge of Excel is a plus

·        Ability to preserve and maintain the highest degree of confidentiality

·        Excellent organizational skills, high attention to detail and accuracy

·        Must be able to remain composed and adaptive in a dynamic, fast-paced, customer-focused work environment characterized by rapid change, minimal lead times and multiple competing priorities

·        Strong verbal/written communication skills

·        Excellent decision making skills

·        Ability to work independently and with minimal supervision but also be able to work within a team environment

Hours: 40 hours between 7:30am – 5:00pm

Length: Direct Hire

Pay for the Credentialing Specialist position: $17.00 - $19.00 / hr. – based on experience

Location: Madison, WI

Job I.D. 136104

·        Union environment

·        Benefits effective first day of employment

·        Health insurance

·        Dental insurance

·        Vision insurance

·        Life insurance

·        Disability insurance

·        Flex spending

·        HSA

·        Paid vacation

·        Paid holidays

·        Paid maternity leave

·        Employee assistance programs

To learn more about Cadre and to view hundreds of immediate openings, please visit our website at www.cadreservices.com.