Credentialing Specialist I

Job Description:

Remote- M-F 8:4:30 PM EST

Data entry of provider credentialing applications into Salesforce

Review daily reports for missing information to update in Salesforce.

Email providers for missing credentialing information or to schedule site visits.

Review weekly term in process report to compare to QNXT for credentialing updates.



Must Have Skills: Data entry experience

Day to Day Responsibilities:

Data entry from resources into Salesforce

Email providers for missing credentialing information

Does not require certification



Summary:

Responsible for coordinating all aspects of the credentialing and primary source verification process for practitioners and health delivery organizations according to Client policy and procedures.



Essential Functions:

Processing Specialist Process initial and recredentialing applications from providers, meeting departmental requirements. Complete data entry of applications, reviewing them for errors prior to turning in the provider files for quality review, meeting departmental requirements. Process the minimum number of provider applications each month, meeting departmental requirements.

Recredentialing/Termination Specialist Prepare and send out recredentialing groups, meeting departmental requirements.

Complete 1st, 2nd and 3rd requests for recredentialing packets, meeting departmental requirements. Send report to various state plans/departments to identify any providers who havent returned their recredentialing applications or who are past-due for credentialing, meeting departmental requirements.

Ongoing Monitoring/Watch Follow-up Specialist Complete follow-up for provider files on watch status, meeting departmental requirements.

Ensure that follow-up occurs for the ongoing state license action monitoring reports, meeting departmental requirements.

Ensure that follow-up occurs for the ongoing Medicare/Medicaid sanctions monitoring reports, meeting departmental requirements.

Delegation Specialist Maintain the minimum volume of delegated provider entered into CACTUS to ensure expected levels of productivity, meeting departmental requirements. Enter data into CACTUS of delegate information should be done within required timeframes, meeting departmental requirements.

Update delegate information received from delegate groups should be completed within required timeframes, meeting departmental requirements.



Knowledge/Skills/Abilities:

Ability to multi-task efficiently. Superb written and verbal communication skills. Competence with computers and data entry.

Knowledge of NCQA, CMS, and Client credentialing criteria.

Ability to professionally adapt to a rapidly changing environment and rule set.

Excellent verbal and written communication skills Ability to abide by Clients policies Ability to maintain attendance to support required quality and quantity of work Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Required Education: High School Diploma or equivalent



Required Experience:

0-2 years of relevant experience



Required Licensure/Certification:

Certified Provider Credentialing Specialist (CPCS) or, participation in a CPCS progression program.



Comments for Suppliers: Will require dual monitors