Role Name: Credentialing Specialist
Location: Columbia, SC 29229
Work Environment: Onsite
Schedule: Mon to Fri, 8:30 am - 5pm  (Some optional overtime) 
Contract length: 3 months assignment with possible conversion


Job Summary:
Duties/About the role:
Responsible for the completion of the initial credentialing and re-credentialing process of providers to the network for various lines of business across the company. Maintains credentialing database and ensures provider databases are current and accurate. Provides assistance to network staff, providers, contract services, marketing, and medical affairs. Ensures compliance with external review organization standards and delegation agreements.

Day to Day:

• 35% Performs initial and re-credentialing of providers/practitioners including documenting credentialing information according to established policies/procedures. Completes primary verification of the following: state licensure, state/federal controlled substance certification, educational and/or residency background, malpractice coverage/history, hospital privileges, and previous sanctions.
• 35% Maintains credentialing database and HCS data files with appropriate network indicators and effective dates. Ensures provider databases are kept current and accurate. Retrieves and interprets credentialing database information for use in various reports.
• 20% Communicates (both verbally and in written form) with providers, provider relations, marketing, other credentialing departments, and various management staff relating to any urgent matters. Registers all participating providers and assists provider network personnel in maintaining and/or updating directory information. Responds to calls/correspondence from physician/provider/office staff regarding participating networks, directories, and provider credentialing. Ensures communication of provider profiling and performance information with other provider services areas. Prepares correspondence and credentialing reports as requested by management.
• 10% Assembles necessary information on providers due initial credentialing or re-credentialing for presentation to credentialing committee. Attends meetings of credentialing committee as scheduled. Assists in research, redevelopment, and implementation of any new programs/projects. Performs quality control checks/reviews/oversight of delegated entities including traveling as required to perform credentialing delegation audits. Present delegated audit findings to credentialing committee.

Team Info: Everyone in the department works together to get the provider credentialing completed. PNS is a family within the CBA family. We work together to accomplish all requirements of the provider network services area and our Behavioral Health provider population. We share laughs and help each other daily. We work through the day by the saying that “Teamwork makes a Dream work”.

Any extra/additional job info: NA

Job Requirements:
Required Experience: 2 years experience in the healthcare or insurance industry.
Required EDU: Associate's Degree or Two years of related work experience
Required Certification or licenses: NA
Required Software and Tools (Hands on experience required): Microsoft Office
Soft skills: communication skills
Nice to have/Preferred skills: Strong work ethics and professionalism. Critical thinking and problem solving. Strong time management skills
  

About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
 
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
 
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
 
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer. 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $17.00/hr.