Credentialing Specialist

Careington International Corporation•Frisco, TX

34d•Hybrid

About The Position

Careington International Corporation is a solutions-oriented company and an established leader in the field of discount healthcare since 1979. Our mission is to create discount health programs that are marketable to the employer, profitable to the provider, and economical for the member. In response to a growing demand for our products and services, our growth means that we continuously strive to recruit innovators to join our fast-paced, forward-thinking team. Careington International is looking to add a new team member to our Dental Network Development team. This is a fulltime, hybrid position that will be worked Monday-Friday from 8:00am CST to 5:00pm CST with office attendance required Tuesday through Thursday. Please note that this position will revert back into office five days a week sometime in Spring/Summer 2027.

Requirements

1 to 2 years of experience in healthcare credentialing or a related administrative field.
Ability to manage and verify a high volume of detailed provider information, ensuring accuracy and compliance with standards.
Strong verbal and written communication skills with the ability to interact professionally with healthcare providers and internal staff.
Excellent time management and organizational skills to handle multiple credentialing processes simultaneously and meet deadlines.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
Strong analytical skills to identify and resolve credentialing issues quickly.
Ability to handle sensitive provider information in compliance with privacy regulations.

Nice To Haves

College degree preferred but not required

Responsibilities

Manage the credentialing and re-credentialing process for dentists, physicians, and counselors, ensuring compliance with applicable regulations and Careington standards.
Ensure that providers meet the required qualifications, licensure, and certifications to deliver care within Careington’s networks.
Collect and verify credentials for providers including but not limited to licensure, certifications, malpractice insurance, education, and work history.
Manage the timely and accurate completion of initial credentialing and re-credentialing applications.
Ensure all documentation meets legal and Careington requirements for credentialing.
Ensure compliance with state, federal, and accrediting bodies' standards such as CMS, NCQA, URAC, and others.
Assist with other departmental projects.
Conduct primary source verification (PSV) including but not limited to appropriate licensure, board certifications, malpractice claims, education.
Utilize online databases and resources (e.g., CAQH, NPPES, AMA, etc.) for verification purposes.
Maintain accurate provider records and databases, updating information regularly as per credentialing requirements.
Ensure that provider profiles are complete, including all required documents and current credentials.
Serve as a point of contact for providers regarding credentialing status, document requests, and issues related to credentialing.
Maintain professional communication with providers to ensure that their applications and re-credentialing are processed efficiently.
Address and resolve discrepancies or issues related to provider credentials, ensuring timely solutions are provided to maintain compliance and prevent delays in provider participation.
Collaborate with team members and other departments to ensure smooth and efficient credentialing operations.