Credentialing Specialist

The Credentialing Specialist will report to OneOncology’s Credentialing Supervisor. The credentialing specialist is responsible for all aspects of the privileging and credentialing process for physicians and allied health professionals. The Specialist will process applications, verify information, research application details, and assure processes are in accordance with medial staff procedures. The specialists will provide consistent, accurate, and timely credentialing support, enhancing the organization’s ability to provide professional services. Work includes the accurate, timely and documented verification of the information provided by the application and maintenance of the highly confidential credentialing related files.   

Responsibilities 

• Credentialing and re-credentialing of physicians and advanced practice providers. 

• Completion, submission and tracking of credentialing applications with all managed care organizations and hospitals.  

• Apply for and validate hospital privileges. 

• Obtain malpractice insurance policy. 

• Notification to staff of completion of credentialing for scheduling and billing. 

• Maintain and update CAQH online credentialing application for all providers quarterly. Database management/provider files. 

• Maintain vital provider credentialing information via technology tool and hard copies of documents in provider files stored on OneOncology platform.  

• Tracking and maintaining all clinical licenses for nursing, pharmacy, and lab personnel. 

• Provider continuing education 

• Track continuing education credits for all providers. 

• Notify providers of any deficiencies. 

• Submit documentation if providers are audited. 

• Termination of physician and/or allied health professional. 

• Contact all MCO/hospitals/EMR to remove provider who has left practice, within 30 days of termination.  

• Other tasks as assigned to drive our mission of improving the lives of everyone living with cancer.  

Key Competencies 

• Experience working with NCQA criteria and third-party payer regulations. 

• Experience with completing hospital credentialing applications. 

• Proficient with MS Office Suite (word, excel) and web-based applications. 

• Ability to maintain verbal and written communications in a confidential manner. 

• Detail oriented with strong organizational skills. 

• Excellent interpersonal skills – team player who can prioritize multiple responsibilities, manage a large workload within tight deadlines – works well under pressure and consistently meets deadlines, readily adapts to change, and excels in a productivity-based environment. 

• Demonstrates research and problem-solving skills. 

Qualifications 

• Current working knowledge of enrollment processes with California payors, Commercial and Government. 

• High school diploma and 2+ years of related experience.  

• Bachelor’s degree preferred.  

• Industry experience leading credentialing activities in large provider practice (or multiple practices) is required. 

• Certifications preferred but not required. 

• Working remote with Travel flexibility as needed.  

• Working Pacific Standard Time hours. 

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