Spec Credentialing I / OPEIU

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.

1. Conduct initial and ongoing credentialing and re-credentialing of healthcare providers in accordance with industry standards and regulations.
2. Review and verify provider applications, credentials, and supporting documentation for accuracy and completeness.
3. Communicate with providers and internal stakeholders to obtain missing or additional information as needed.
4. Maintain accurate and up-to-date provider data in the credentialing database.
5. Conduct primary source verification of provider education, training, licensure, and other credentials.
6. Ensure compliance with all regulatory and accreditation requirements related to provider credentialing.
7. Monitor and track expiration dates of provider credentials and take necessary actions to maintain compliance.
8. Identify and escalate any potential issues or discrepancies in provider credentials to management.
9. Assist with audits and investigations related to provider credentialing.
10. Collaborate with cross-functional teams to improve processes and enhance the overall quality of credentialing.
11. Provide exceptional customer service to all internal and external stakeholders regarding credentialing inquiries.
12. Stay current on industry trends and best practices related to provider credentialing.
13. Maintain confidentiality and adhere to all HIPAA and privacy regulations.
14. Participate in training and development opportunities to enhance knowledge and skills.
15. Other duties as assigned by management.

According to JobzMall, the average salary range for a Spec Credentialing I / OPEIU is $48,000 - $60,000 per year. This can vary depending on factors such as location, experience, and employer.

Highmark Inc. is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark and its diversified businesses and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.2 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies.