Senior Credentialing Specialist

The Senior Credentialing Specialist supports the mission, core values, and customer service standards of DCC Consultants. This role adheres to the DCC Consultants Policies and Procedures and Compliance Program, including all state and federal regulatory requirements. The Credentialing Specialist oversees the credentialing responsibilities for ensuring providers are credentialed with health plans and hospitals PHO’s. They maintain up-to-date data for each provider in credentialing databases and online systems.

Primary Duties and Activities:

• Compile and maintain current and accurate data for all providers.
• Maintain corporate provider contract files.
• Stay updated on current health plans and agency requirements for credentialing providers.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.
• Track licenses, certifications, and malpractice expirations for all providers to ensure timely renewals.
• Process applications for appointment and reappointment of privileges to DCC Consultants Physicians.
• Set up and maintain provider information in online credentialing databases and systems.
• Ensure practice addresses are current with health plans, agencies, and other entities.
• Audit health plan directories for current and accurate provider information.
• Participate in individual and group projects as directed by management.
• Cross-train on the provider credentialing specialist as needed.
• Act as the point of contact for questions and issues relating to credentialing and insurance contracts, including communicating with the manager when new changes need to be made in processes, services, or billing.
• Resolve issues related to credentialing, including insurance contracts, hospital applications, and other necessary information.
• Perform other duties as assigned.

Requirements

Education and Experience :

• 5 years of experience in credentialing for a physician practice or healthcare sector.
• Bachelor’s Degree in Business or a related field.

Required Skills:

• Proficiency in PC and ability to thrive in a fast-paced setting; experience with Microsoft Office Suite: Outlook, Word, and Excel is a plus.
• Good presentation and communication skills.
• Productivity and resourcefulness with the ability to meet deadlines.
• Experience with Availity, CAQH, Optum, MultiPlan, and other credentialing databases.

Benefits

Workdays: Monday - Friday

Work hours : 6 pm – 3 am PKT (Night shift)

Gross Salary (USD): $700 - $800

Benefits: Annual Bonus, Eid Bonuses, Provident Fund, Health Insurance (IPD, OPD), Fuel Card or Company Pick & Drop, EOBI, Free Meal