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Credentialing Assistant

1 month ago
United States
Full-time
Entry Level
Human Resources
Operations
Apply Now
Dane Street

Dane Street

Dane Street provides independent medical examination and peer review services tailored for the insurance industry, focusing on areas such as workers' compensation, disability, and auto liability, while emphasizing quality, compliance, and timely delive...

Insurance
251-1K
Founded 2008
View All Jobs 44

Description

  • Enter reviewer application data and maintain electronic reviewer files.
  • Perform online searches and primary source verification for board certifications, licenses, background checks, and malpractice checks.
  • Upload credentialing documents and prepare Judgments pages with Medical Director comments.
  • Communicate application status to the Operations team, including denials and Do Not Use decisions.
  • Process recredentialing applications and refer reviewers with red flags to the Medical Director.
  • Review licenses, certifications, and workers’ compensation registrations for expiration status.
  • Create, receive, and document sanctions, exclusion, and background check reports, including supporting court or NPDB documentation.
  • Manage reviewer reactivation, deactivation, profile updates, Do Not Use status, contact data, and W-9 requests.
  • Enter updated fee schedules and obtain new fee agreements as needed.
  • Participate in Quality Management Committee meetings and follow-up activities, and support team members with credentialing-related questions.

Requirements

  • Associate’s degree or Bachelor’s degree preferred.
  • Credentialing experience in a healthcare or insurance setting preferred.
  • Knowledge of URAC and relevant state and federal guidelines.
  • Excellent communication skills and understanding of medical terminology.
  • Strong critical thinking skills and the ability to manage time efficiently and meet deadlines.
  • Computer literacy and typing skills required.
  • Ability to perform job duties that may involve lifting, bending, traveling, and long periods of sitting and computer work.
  • Must supply and maintain uninterrupted internet service for work-from-home duties.

Benefits

  • Medical, dental, and vision coverage for employees and their families.
  • Voluntary life insurance for employees, spouses, and children.
  • Additional voluntary coverage options including hospital indemnity, critical illness, accident indemnity, and pet insurance.
  • Basic life insurance, short-term disability, and long-term disability at no cost.
  • Generous paid time off.
  • 401(k) plan with company match.
  • Apple equipment and a media stipend for remote workspace.

Interested in this position?

Apply directly on the company website

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