Contract Credentialing Specialist

Wheeler Staffing Partners is hiring a Contract Credentialing Specialist on a contract basis with a healthcare client in Dallas, TX .

The Sr. Credentialing Specialist will work closely with the local market onboarding team on all new providers in the pipeline.

This is an on-site role, reporting to the Dallas office Mon-Fri.

Credentialing Specialist Job Responsibilities :

• Requests all credentialing data and supporting documents from the physician. Communicate to the market onboarding team when delays with the physician are in jeopardy of interrupting the defined project timelines.
• Candidates should know NCQA standards, delegated credentialing, and Primary Source Verification.
• Prepare and / or update the provider’s CAQH application for newly affiliated and existing healthcare providers.
• Ability to build and maintain peer-to-peer relationships with all relevant market Health Plans. Strategically communicate with newly affiliated providers to plan to initiate TIN change / demographic flip or initiate credentialing.
• Display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicate issues, trends, and concerns to the Regional Supervisor.
• In-depth working knowledge of the various applications associated with all plans and the workflow process. Identify any opportunity for process improvement and work with the Regional Supervisor to challenge payors' agendas.
• Issue resolution relating to billing and collecting for services rendered. Educating internal markets on contractual obligations for each payor surrounding managing authorizations, billing requirements, and operationalizing language to ensure that we can bill and collect for services rendered.
• Provide credentialing information to Market Operations to ensure that they have the information needed to effectively manage the practices from a credentialing perspective.

Sr. Credentialing Specialist Job Requirements :

• Minimum of four years of experience in a managed care role, centralized credentialing office, or related health care environment, such as credentialing or file maintenance.
• Knowledge of health plan and governmental payer credentialing, enrollment, and requirements.
• Knowledge of CAQH application.
• Knowledge of contract language interpretation and administration
• Demonstrated problem-solving and customer service skills.
• Knowledge of Microsoft Word and other PC applications.
• High School Diploma required; completion of an applicable Vocational or Technical training program preferred.

WSP specializes in filling your company’s contract, contract-to-hire, direct hire, contingency, and executive positions with professional candidates.

From our Executive Retained Search Teams, Direct Hire and Contract Staffing Professionals, and RPO Service offerings we create models to deliver a world-class service, with a sense of urgency and professionalism.

Our connections and our candidates combined with a staff backed by over 20 years of experience, ensure that our clients are seeing the right candidates for their career openings.

WSP is committed to creating a diverse environment and is proud to be an equal opportunity employer.