Credentialing Administrator - Hybrid - Elkin, NC

At Prism Medical Products, we're not just offering jobs-we are building careers!

As part of our dynamic team, you'll be empowered to make a meaningful impact every day. Whether you're on the frontlines of patient care, operations, or support services, you'll play a vital role in delivering the innovative and patient-centered solutions that define Prism CARE Solutions.

We're searching for motivated individuals to elevate our expertise, support our mission, and help deliver outstanding results. Join us to thrive in a fast-paced, collaborative environment that values growth, compliance, and delivering an exceptional client experience. If you're ready for a fulfilling, long-term career that makes a real difference, we'd love to hear from you!

Prism CARES for Our Employees!

We don't just say it-we show it. Prism CARES represents our commitment to combining access, resources, and expertise to support our employees while they support our patients and providers.

C - Cultivating growth and balance: We empower personal and professional development through comprehensive health benefits, generous paid time off, and a commitment to work-life harmony.

A - Access to industry-leading benefits: From 401k matching and tuition assistance to company-paid holidays and employee engagement events, we offer the tools and perks you need to succeed.

R - Resources for success: With tailored coaching, professional development programs, and training opportunities, we're committed to helping you achieve your goals.

E - Expertise and support: You'll benefit from unmatched onboarding, advanced learning resources, and insights developed from real-world experience.

Join Our Team at Prism!

The Credentialing Administrator manages provider credentialing and recredentialing to ensure compliance with regulatory, accreditation, and organizational standards. Responsibilities include primary source verification, maintaining credentialing records, facilitating provider participation approvals, and reviewing and tracking more than 550 provider contracts during the recredentialing cycle. This role collaborates with internal teams, providers, and external organizations to ensure accurate documentation and ongoing compliance

A Day in the Life of a Credentialing Administrator

• Coordinate and manage the full lifecycle of provider credentialing and recredentialing, including primary source verification of education, training, licensure, certifications, malpractice coverage, and work history.
• Maintain accurate credentialing records and databases, monitor expiration dates for licenses and certifications, and initiate renewals to ensure ongoing compliance with regulatory and accreditation standards such as those established by The Joint Commission and National Committee for Quality Assurance.
• Prepare credentialing and recredentialing files for review and approval while ensuring all documentation meets organizational and regulatory requirements.
• Review and track more than 550 provider contracts during the recredentialing cycle, ensuring alignment with organizational policies, payer requirements, and contract terms.
• Collaborate with legal, compliance, payer relations, and internal departments to resolve discrepancies, maintain documentation, and support audits or compliance reviews.
• Serve as a primary point of contact for providers and internal stakeholders regarding credentialing documentation, contract updates, and status reporting. Administrates and organizes communication to management regarding industry trends and payer updates to determine the overall impact of these changes to the organization.
• Prepares and delivers monthly/quarterly target reports to departments that are involved with or impacted by payer contracts to include target plans, contract acquisitions, contract denials and formulary plans.
• High level proficiencies of all facets within Payer Relations including, but not limited to credentialing, contracting, EDI, Zoho CRM, internal and external payer databases, communications, and administrative maintenance responsibilities.
• Pursues continual high-level understanding and execution regarding Medicare and non-Medicare payers, Medicaid and Managed Care Organizations, and Workers' Compensation plans as it pertains to regulatory standards and compliance, as well as a keen understanding of industry-related competition and current market.
• Demonstrates professionalism and promotes positive interpersonal relations with all internal and external business contacts, representing the organization in a positive manner, and displaying personal commitment to achieving goals and objectives.
• Supports and serves as a resource for all department shortages and questions.
• Adheres to company policies and procedures regarding employment, safety, and compliance, and report any concerns of non-compliance in any area to your manager immediately.
• Performs other duties as required and assigned by the Payer Relations Manager and leadership.

Education and Qualifications:

• Highschool Diploma or equivalent, associate or bachelor's degree in business or other healthcare related field and 1-3 of healthcare experience, preferred or any similar combination of education and experience.
• General knowledge of medical business organization and operations.
• General knowledge of government and commercial insurance regulations.
• General computer and internet navigation skills.
• Proficiency in Microsoft applications (Word, Excel, PowerPoint and Outlook).
• Effective verbal and written communication skills.
• Attention to detail in composing, typing, and proofing materials, establishing priorities and meeting deadlines.
• Ability to work in a fast-paced environment with demonstrated ability to juggle multiple competing tasks and demands.
• Ability to professionally interact and communicate with individuals at all levels of the organization.

Benefits

Health, Dental, Vision, Life, Disability, 401K, Company Paid Holidays, Paid Time Off, Education Assistance Program, Community Involvement, Employee Engagement Opportunities.

Hours

Full-time: Monday-Friday, 8:00am-5:00pm

Are you ready to elevate your career and make a meaningful impact in healthcare? If you're passionate about driving results, thriving under pressure, and contributing to a mission-driven organization, we invite you to become part of Prism's dynamic team. Join us for a rewarding and impactful career where your expertise will make a difference every day!

At Prism, we're not just a company; we're a team dedicated to making a difference for our patients, our partners, and our employees. Apply now and discover how a job at Prism can become the career of your dreams.

Education/Experience/Knowledge Requirements:

• Highschool Diploma or equivalent, associate or bachelor's degree in business or other healthcare related field and 1-3 of healthcare experience, preferred or any similar combination of education and experience.
• General knowledge of medical business organization and operations.
• General knowledge of government and commercial insurance regulations.
• General computer and internet navigation skills.
• Proficiency in Microsoft applications (Word, Excel, PowerPoint and Outlook).
• Effective verbal and written communication skills.
• Attention to detail in composing, typing, and proofing materials, establishing priorities and meeting deadlines.
• Ability to work in a fast-paced environment with demonstrated ability to juggle multiple competing tasks and demands.
• Ability to professionally interact and communicate with individuals at all levels of the organization.

Physical Requirements:

• In an 8 hour day the employee lifts/carries 10 LBS rarely.
• In an 8 hour day the employee stands 1 hour.
• In an 8 hour day the employee sits 7 hours.
• In an 8 hour day the employee drives a vehicle 0 hours.

This position is currently accepting applications.

Apply Now