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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.).
Perform other duties as assigned.
Additional Responsibilities:Candidate Education:
Required A High School or GED
Required 2 years of experience in a customer service or healthcare related position
Preferred 1 year of experience in Credentialing
Intermediate Demonstrated written communication skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to work as part of a team
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Other Knowledge of credentialing software sufficient to develop appropriate reports on all aspects of credentialing
Licenses and Certifications: A license in one of the following is required:
Preferred Other Certified provider credentialing specialist or directly related or equivalent work experience
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Required Intermediate Microsoft Outlook
Required Intermediate Other Ability to learn various software packages as may be necessary to perform job functions