Job Description

Job Description

Job Description

#11461

Introduction

Visium Resources has been asked to identify qualified candidates for this Credentialing Specialist position. This position is a contract to hire opportunity which is expected to be Remote for a duration of 3 months+ to direct.

Requirements:

The Credentialing Specialist reports to the Network Operations Manager. The Credentialing Specialist is responsible for activities associated with credentialing or re-credentialing of network providers, including review of providers credentialing documentation, processing, loading providers into the tracking database system to ensure high quality standard are maintained.

Responsibilities:

• Credentialing Specialists will assist with audits, provide feedback to reduce errors and improve processes and performance.
• Works with the Provider Representatives and provider practices to gather documentation required for the Initial and Re-credentialing process. Acts as support to the CVO for the PHSO teams.
• Responsible for supporting and adhering, to all quality assurance activities that promote company and agency compliance. Identifies and reports on process improvement opportunities to the manager and assists with improving all quality assurance policies and procedures.
• Actively seeks to model the achievement of excellence.
• Promote teamwork by personally adopting principles of caring and integrity. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
• Collects Initial and Re-credentialing applications from provider representatives and provider practices, evaluates them for completeness, and submits to credentialing specialists.
• Support NCQA audit processes and ensure all credentialing QA standards and processes are followed.
• Evaluates provider documentation in preparation for re-credentialing cycles and notifies leadership of any issues.
• Monitors credentialing cycle and reviews re credentialing lists to ensure compliance with all accrediting, and regulatory agencies, and PHSO requirements and standards.
• Maintains open communication with provider representative and keeps them informed of the credentialing status of their providers.
• Evaluates and follows up on non-compliant physicians and facilities and makes recommendations for corrective action when necessary.
• Prepares end-of-the-month reports to communicate the outcome of credentialing committee meetings and notifies providers of the outcome of their application.
• Assists in mailing initial credentialing applications as authorized by leadership as well as mailing and follow-up re-credentialing applications with providers per timelines specified in PHSO policies and procedures
• Assists in answering all incoming telephone calls, prepares mail-outs to providers and is responsible for other special projects as assigned
• Responsible for maintaining and filing (manual and electronic) provider files, responding to request(s) to retrieve and create files. Follows set PHSO policies and procedures in inventory of all files.
• Sets up all practitioner files, scans and uploads contracts and other key documents as specified in the credentialing workflow.
• Prepares provider grids and profiles for review/approval by the Credentialing Committees
• Support the coordination of meetings, managing deadlines and agenda and compilation of all meeting materials.
• Assists with completing minutes within one week of the meeting. Assists with all follow-up items, documentation and coordination of the credentialing cycle.
• Assists with follow-up activities which occur after credentialing and re-credentialing committee meetings. This includes notifying other teams of providers approved, sending welcome letters and sending re-credentialing confirmation letters to those providers who are re-credentialed within one week of the Credentials Committee.

Job Requirements:

Required:

• Experience with provider enrollment in a healthcare setting such as a facility, urgent care, or hospital. Proficiency required in CMS systems, MD-Staff, Adobe Pro, and Microsoft Excel. Familiarity with NCQA standards required. CPCS and/or CPMSM certification through NAMSS required.

• Minimum of five years of professional secretarial, administrative, credentialing, provider network, medical staff facility or provider facility experience.
• High-level interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams across department lines, management levels, and business entities.
• High degree of emotional intelligence and self-management ability. Able to remain calm, focused, and productive in stressful situations, conflicts.
• Excellent organizational, planning and time management skills.
• Strong attention to detail skills
• Excellent analytical and problem-solving skills
• Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff.
• Ability to communicate with individual staff and teams of all levels
• Proficiency in Microsoft Office Outlook, Word, Excel, and PowerPoint
• Ability to work in a matrix-management environment to achieve organizational goals
• Work experience and knowledge of NCQA guidelines
• Excellent reasoning, problem solving, prioritization and business judgement.
• Working knowledge of typical health plan or Medical Staff Credentialing operations.

Education Required:

• Associates degree or 3 years of experience in the field of health insurance (HMO, health insurer, TPA, broker, Quality Assurance, physician practice or healthcare setting) sufficient to yield the knowledge requirements.

Education Preferred:

• Bachelor's degree in a related field, such as Healthcare, Business, Marketing, or Communications

Visium Resources is an award-winning employment firm with a mission to match talented individuals with highly successful organizations. At Visium, our company's success is based on your success. When you work with us, you are never 'just a number'. You are our most important asset. Here, you will know us by name through our regular visits to client sites and even occasional luncheons. We will always be there when you need assistance and will always go the extra mile to ensure that you are as successful as possible. Whether you're looking for contract, contract-to-hire or permanent opportunities, we firmly believe there is no employment agency that will work harder for you than Visium.

Visium Resources is an equal opportunity employer and values diversity. All employment is decided based on qualifications, merit and business need.

 

Company Description

Visium Resources is an award-winning employment firm with a mission to match talented individuals with highly successful organizations. At Visium, our company’s success is based on your success. When you work with us, you are never “just a number”. You are our most important asset. Here, you will know us by name through our regular visits to client sites and even occasional luncheons. We will always be there when you need assistance and will always go the extra mile to ensure that you are as successful as possible. Whether you're looking for contract, contract-to-hire or permanent opportunities, we firmly believe there is no employment agency that will work harder for you than Visium. Visium Resources is an equal opportunity employer and values diversity. All employment is decided based on qualifications, merit and business need.

Company Description

Visium Resources is an award-winning employment firm with a mission to match talented individuals with highly successful organizations. At Visium, our company’s success is based on your success. When you work with us, you are never “just a number”. You are our most important asset. Here, you will know us by name through our regular visits to client sites and even occasional luncheons. We will always be there when you need assistance and will always go the extra mile to ensure that you are as successful as possible. Whether you're looking for contract, contract-to-hire or permanent opportunities, we firmly believe there is no employment agency that will work harder for you than Visium. Visium Resources is an equal opportunity employer and values diversity. All employment is decided based on qualifications, merit and business need.

Job Tags

Permanent employment, Contract work, Work experience placement, Work at office,

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