Education, Knowledge, Skills and Abilities
- High School Diploma or GED Required
- Bachelor’s preferred
- A strong working knowledge of Microsoft Office Suite
- A thorough knowledge of credentialing, re-credentialing, enrollment and delegated credentialing activities
- Requires critical thinking and analytical skills, decisive judgement, and the ability to work with minimal supervision
- Strong interpersonal skills along with demonstrated verbal and written communication skills
Length and Type of Experience
- Minimum of one year of direct experience, including credentialing experience in a hospital and/or managed care setting
- Multi-specialty provider group payor enrollment and credentialing experience
- Experience with CMS, state license requirements, and other regulatory and accrediting entities preferred
Licensure or Certification
- Certified Provider Credentialing Specialist (CPCS) certification by the National Association Medical Staff Services preferred
Physical and Environmental Demands
- Manual dexterity sufficient to operate basic office equipment
- Occasional lifting or carrying of up to 25 pounds
RESPONSIBILITIES
- Collaborates with Director to analyze current data structure, prepare for future data needs, collect and analyze required information to compile and report on
- Completes Medicare, Medicaid and BWC validations and revalidations as needed
- Process paperwork for insurance credentialing purposes and tracks activity to support payor follow-up as needed
- Work with all physicians and recruiters to obtain necessary information to complete and submit forms in order to achieve credentialed status in a timely manner
- Recredentials physicians on a timely basis to ensure continued participation in insurance plans
- Maintain files on each physician containing key documents
- Track expirations dates and proactively work to renew credentialing
- Development and implementation of audit tools to monitor and assess operations, policies and procedures of the credentialing process
- Development, evaluation and monitoring of credentialing forms, checklists, policies and documentation practices for the purpose of determining compliance with regulatory agencies
- Performs audits and analyzes results to develop recommendations for resolving identified issues and to develop best practices
- Assist with Managed Care contracting to ensure good conditions to execute timely credentialing
Benefits
- Competitive salary package
- Extensive benefit package including medical, dental, vision, and life insurance (Benefits on Day 1!)
- Accident & critical illness insurance
- Tuition Reimbursement
- Short-Term & Long-Term Disability Insurance
- Paid Maternity Leave
- Employee Assistance Program
- Paid Time Off
- Employee Wellness Plan that pays you for being healthy
- 403(b) and Roth Retirement Plan with company matching
- We are a qualifying employer for the Public Service Loan Forgiveness (PSLF) Program which allows you to receive forgiveness of the remaining balance of your Direct Loans after you have made 120 qualifying monthly payments while working full-time for a qualifying employer
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