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Provider, Facility, Ancillary credentialing, to include all aspects of the new applicant credentialing, re-credentialing; ongoing maintenance of provider credentials; report preparation, online verifications; serve as a trainer for credentialing associates; address escalated, complex cases.
Daily management of associates and processes which includes but not limited to: payroll, development and performance management. Provides significant input into associates' performance evaluations and hiring/termination situations.
Review applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing.
Oversight of assigned CVO vendor processing.
Prepare files and materials for internal and external regulatory audits.
Maintain and update credentialing database and core system records.
Oversight of re-credentialing mailing, voluntary relinquishment and reinstatement processes.
Review issue cases prepared for Medical Director and Credentialing Committee review.
Attend and provide support for all assigned Credentialing Committee meetings.
General project management in support of department operations.
Liaison with assigned Configuration and Market personnel.
Create and maintain reports.
Provide training and support to credentialing associates and assist with handling complex questions and case reviews.
Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc.).
Perform other duties as assigned.
Required A High School or GED
Required 4 years of experience in credentialing in a hospital or managed care setting
Required 1 year of experience in leading others
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 Ability to explain complex credentialing standards and processes to team members.
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
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Required Intermediate Microsoft Outlook
Required Intermediate Other Ability to learn various software packages as necessary to perform job functions.