Credentialing Specialist -
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POST DATE 8/30/2016
END DATE 11/27/2016
JOB DESCRIPTIONJOB SUMMARY ---- Provider. Facility and Ancillary credentialing.
To include all aspects of new applicant credentialing, re-credentialing; ongoing maintenance of provider credentials; online verifications; administrative support of credentialing functions.
Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing.
Perform all required primary source verifications.
Contact hospitals, licensing agencies, malpractice carriers, and medical schools to obtain credentialing verifications.
Maintain and update credentialing database records.
Review malpractice history, regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures.
Review the CAQH system and download applications or supplemental documents as appropriate.
Maintain electronic provider files.
Perform outreach to providers and facilities via phone calls and fax/email correspondence.
Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA. CMS. Medicaid. etc.).
A High School or GED Required
1+ year of experience in a hospital, provider or managed care setting
2+ years of experience in a customer service or health care related position
Demonstrated written communication skills
Demonstrated interpersonal/verbal communication skills
Ability to work as part of a team
Ability to effectively present information and respond to questions from peers and management
Knowledge of credentialing software sufficient to develop appropriate reports on all aspects of credentialing
Ability to learn various software packages as may be necessary to perform job functions
We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.
Some experience in Credentialing is a must