Randstad Credentialing Specialist in Smithfield, Rhode Island

Credentialing Specialist

job details:

  • location:Smithfield, RI

  • salary:$23 - $24.50 per hour

  • date posted:Wednesday, January 2, 2019

  • experience:Experienced

  • job type:Temp to Perm

  • reference:S_718105

job description

Credentialing Specialist

Under general supervision, processes health plan provider credentialing and re-credentialing. Reviews applications, prepares letters and maintains database.Communicates with providers by phone and mail regarding credentialing status. Responsible for complying with state, federal and company policies and compliance with state and NCQA requirements.


? Initiates outreach communications to practitioners/providers

? Enters all information from initial and re-credentialing applications into a database and verifies with appropriate sources

? Maintain, crosscheck and update database with demographic changes and other pertinent information and create change request forms

? Responsible for generating reports, documentation and correspondence and accurately documenting determinations

? Compile data for NCQA, DHS, CMS reporting and audits

? Maintaining absolute file integrity with regards to content, location and confidentiality

? Prepare files for credentialing committee review

? Ensures that all data is maintained, transmitted and stored in a confidential and secure manner in compliance with applicable state, federal regulations and as required by company policies and procedures and is organized appropriately for audits and regulatory review

? Serves as the database expert for the credentialing department and produces regularly scheduled and ad hoc reports

? Conduct regular reviews of disciplinary action reports issued by State licensure bodies; Office of Inspector General Medicaid and Medicare Sanctions report; Identify any participating providers that appear in the databases and invoke the appropriate process as defined in policy and procedures

Working hours: 1:00 AM - 5:00 PM


--Ability to learn various software packages as necessary to perform job functions

--Intermediate skills in Microsoft Office (Excel)

--Experience with CACTUS or similar systems

--Working knowledge of managed care and/or credentialing






? High School diploma or its equivalent

? Minimum of two (2) years credentialing, quality or provider operations experience

? Able to independently managing multiple tasks

? Good communication skills telephonically and in person with internal and external customers

? Ability to work collaboratively with peers to support a team environment

? Ability to understand, interpret and apply regulatory guidelines and company policies and procedures to credential practitioners

? Detail oriented l

? Intermediate skills in Microsoft Office (Word, Outlook)

Contract position - Immediate start

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.