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Credentialing Specialist

2 months ago

El Centro, United States Southern California Spine Full time
Job DescriptionJob DescriptionSalary: 18-20 per hour


Would you like an exciting position as a  Credentialing Specialist with growth potential with a talented group of teammates who genuinely cares about you as much as they do patient care? Then Southern California Spine is the place for you Join a team based approach in Pain Management where you a have a direct impact in preserving life for our patients. SoCal Spine has a broad spectrum of benefits to match any competitor out there. Come work alongside our world class Doctors in our clinic outpatient setting where we focus on You everyday.  We offer competitive compensation and benefits packages. Please apply



Credentialing Specialist

Our company is hiring for a credentialing specialist as a part time contractor . To join our growing team, please review the list of responsibilities and qualifications.

Responsibilities for credentialing specialist

  • Participating in the development and implementation of credentialing processes and procedures
  • Credentialing of physicians and allied health professionals
  • Collecting and maintaining an accurate practitioner database and analyzing verifications
  • Credentialing physicians and allied health professionals
  • Collecting and maintaining an accurate practitioner database
  • Credential Provider through PECOS, MEDICARE, and variety of insurance payers.
  • Manage and Maintain Provider CAQH

 

  • Correct payments or denials if necessary and appropriate, in accordance with claim adjudication guidelines
  • Diffuse irate callers by attentive listening, maintaining a professional tone, and acknowledging their concerns by paraphrasing
  • Exercise good judgment, interpret medical claim data and contracts, and remain knowledgeable in related company policies and procedures
  • Maintain teamwork, customer service production and quality standards to assure timely, efficient and accurate call resolution
  • Maintaining compliance with regulatory and accrediting bodies

Qualifications for credentialing specialist

  • Analyzing verifications
  • Establishing and maintaining a system for timely processing of credentialing and re-credentialing files in accordance with the company, CMS and NCQA policies
  • Ensuring that providers/HDOs on the company's participating panel are in compliance with the company policies and NCQA and state and federal regulatory standards
  • Maintaining current knowledge of NCQA, State and Federal requirements
  • Performing data entry in and maintaining currency of the database for tracking practitioner / HDO credentialing and re-credentialing information
  • Initiating and conducting primary source verification of provider credentials

Licensing or Certifications for Credentialing Coordinator

List any licenses or certifications required by the position: CPCS, CPMSM, NAMSS, GOLD, ECFMG, DEA, BEP/WBE/MBE, NEMT, CPMSC, CMSC

Education for Credentialing Coordinator

Some education preferred, Collage and Associate Degree in Education, Associates, General Education, Medical, Business, Healthcare, Health, High School Education, Health Care, Health Administration

Skills for Credentialing Coordinator

Desired skills for credentialing coordinator include:

Medical terminology

Statutes and laws relating to credentialing

NCQA

Microsoft Office

Accreditation and certification procedures

Practitioner credentialing and primary source verification of medical/dental licensure

Privileging

Related credentialing

Requirements and hospital operations

Title 22

Performing other related tasks as directed by the Associate Executive Director of Quality Management, the Credentialing Director and the Credentialing Team Lead

Perform primary source verification on required elements

Complete data entry and upkeep of provider information in the credentialing database