Credentialing Specialist

Multiplan Inc. Chattanooga , TN 37402

Posted 2 months ago

Job Description:

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

Because our Bedford, MA office is closed for the time being due to the pandemic, you will work from home until the office reopens. Once the office reopens, you will work in the Bedford, MA office each day.

JOB SUMMARY: Supports the Appeals Committee, Credentialing Committee, credentialing and recredentialing programs. Apply team support, and monitoring of the workflow pertaining to the Appeals and Credentialing Committee.


1.Coordinates all practitioner appeals with internal and external representatives

2.Maintain practitioner files with varying levels of appeal

3.Assembles and distributes internal and external correspondence regarding Credentialing Committee decisions

4.Effectively communicate and educate practitioners and internal departments regarding Credentialing Committee decisions

5.Contact practitioner offices to obtain additional information

6.Collects, researches and redistributes undeliverable certified mail

7.Performs all other duties and responsibilities deemed necessary

8.Ensure systematic data oriented efforts to improve consumer and/or client services. 100% of this job is related to QM activities.

9.Collaborate, coordinate, and communicate across disciplines and departments.

  1. Ensure compliance with HIPAA regulations and requirements.

  2. Demonstrate commitment to the Company's core values.

  3. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.


The incumbent is an entry-level position within the Credentialing Specialist job family and works under indirect supervision. The incumbent uses independent judgment and knowledge of policies, practices, and procedures within the field to complete job responsibilities and may require a moderate amount of oversight and direction from management or senior associates in day-to-day tasks and duties. The incumbent refers more complex issues to higher levels. 100% of overall responsibilities that are dedicated to QM functions and include the scope of responsibilities related to QM function.

Note: This position cannot be located in Colorado.

Job Requirements

  • Minimum Associates Degree or 2 years of related experience

  • Minimum 3 years of credentialing experience

  • Knowledge of NCQA and URAC accreditation standards required

  • Required licensures, professional certifications, and/or Board certifications as applicable

  • Communication (written, verbal and listening), problem solving, organizational and interpersonal skills

  • Ability to be service oriented and flexible.

  • Ability to work under pressure

  • Ability to work independently, effectively and well in both individual and team environments

  • Ability to use software, hardware and peripherals related to job responsibilities including MS Office Suites, Microsoft Word and Excel, etc.


We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

  • Medical, dental and vision coverage (low copay & deductible

  • Life insurance

  • Short- and long-term disability

  • 401(k) + match

  • Generous Paid Time Off

  • Paid company holidays

  • Tuition reimbursement

  • Flexible Spending Account

  • Employee Assistance Program

  • Summer Hours


MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you'd like more information on your EEO rights under the law, please [ Link Removed ] .

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Credentialing Specialist

Multiplan Inc.