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Senior Credentialing Specialist

Maumee, Ohio
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Description

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.

 

The Senior Credentialing Specialist (CS) provides support and training for the credentialing area to include coordination of the physician, practitioner and facility applications for initial credentialing and re-credentialing processes according to standards of the National Committee on Quality Assurance and regulatory requirements.

  • Assists Manager in all credentialing aspects of regulatory reviews including, but not limited to, NCQA, ODM, CMS, ODI and ODH. Prepares or reviews all pre-audit documents to assure accuracy. Participates in the staff interview process and assures that all recommendations are implemented to assure continued compliance.

  • Three to five years demonstrated experience in provider credentialing processes, preferably in a managed care setting, with working knowledge of NCQA credentialing standards, required.
  • Certified Provider Credentialing Specialist (CPCS) certification required.
  • Familiarity with medical terminology required.
  • Knowledge of AMISYS provider database and Cactus strongly preferred.
  • Experience using Microsoft Office programs, especially Excel, Word, PowerPoint, and Access required.
  • Exceptional written, telephonic, and oral communication, leadership, problem-solving, interpersonal, analytic, and organizational skills required. Ability to coordinate and organize multiple priorities.
  • Demonstrated ability to maintain detailed and confidential information.

Education

  • High School Degree required
  • Associate’s Degree in related field preferred.

 

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace

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