Credentialing & Compliance Specialist
Prime Health Services, Inc. is one of the fastest growing Healthcare Networks in the United States. We work with great clients who access our network for Workers’ Compensation, Group Health, First Party Auto Medical Liability, and Independent Medical Examinations. We offer specialized networks for Pharmaceutical Management and Imaging Networks.
By offering our clients a national network, we additionally strive to make sure that the quality is preserved in our network by credentialing our participating providers to an NCQA standard. The ideal candidate for this position will have 3-5 years of hands on physician credentialing experience, be familiar with all the aspects of credentialing a provider to participate in a healthcare network. The candidate will be familiar and comfortable with working on the internet, and bring a high degree of ethical conduct to the role dealing with confidential information. Additionally, the candidate will be required to be functional in all Microsoft operating systems and be capable of 70+ WPM and 10-Key Touch preferable.
Additional duties may include:
Conducting research to determine applicable state regulatory requirements
Compiling/tracking this information in our internal databases and sharing it among company groups/divisions.
Ensuring process compliance with credentialing policies (adherence to an NCQA standard), state and federal standards
Monitoring sanctioning information and applying it as necessary to providers
Reviewing sanctions filed and facilitating investigative process
Tracking and documenting investigations
Participating in special projects
Taking calls from physicians/providers
Summarizing reports, information and research
Our employees make a difference in the lives of many through our healthcare services! If you are qualified, we are interested in talking with you. Please forward cover letter, resume, job salary history, and (3) three references to Prime Health. No candidate will be considered without verifiable job salary history. will only be accepted via e-mail at careers@primehealthservices.com.