Job Title: Credentialing Specialist I
Duration: 6 Months
Location: Remote (Long Beach, CA 90802)
Responsible for coordinating all aspects of the credentialing and primary source verification process for practitioners and health delivery organizations according to Company’s policy and procedures.
- Processing Specialist Process initial and re-credentialing 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. Re-credentialing/Termination Specialist
- Prepare and send out re-credentialing groups, meeting departmental requirements.
- Complete 1st, 2nd and 3rd requests for re-credentialing packets, meeting departmental requirements.
- Send report to various state plans/departments to identify any providers who haven’t returned their re-credentialing 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.
- Ability to multi-task efficiently. Superb written and verbal communication skills. Competence with computers and data entry.
- Knowledge of NCQA, CMS, credentialing criteria. Ability to professionally adapt to a rapidly changing environment and rule set.
- Excellent verbal and written communication skills
- 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
High School Diploma or equivalent
0-2 years of relevant experience
Must have requirements: 1 yr credentialing experience; high speed internet to work from home
Minimum years of experience: 1 yr credentialing experience
Certified Provider Credentialing Specialist (CPCS) or, participation in a CPCS progression program.
Day to day responsibilities: Reviewing credentialing applications to submit for processing, answering phone, answering questions in emails, updating database, sending approval letters, and various other tasks