Credentialing Specialist

4 weeks ago


New York, United States Collabera Full time

Description

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Credentialing Specialist

Contract: New York, New York, US

Salary: $23.00 Per Hour

Job Code: 356822

End Date: 2025-01-11
Days Left: 27 days, 2 hours left

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Position Details:

Industry Healthcare

Job Title Credentialing Specialist I

Work Location Remote

Duration 6+ Months

Pay Range $21 - $23/hr

Job Description:
  • Data entry of provider credentialing applications into System.
  • Review daily reports for missing information to update in System.
  • 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
Summary:

Responsible for coordinating all aspects of the credentialing and primary source verification process for practitioners and health delivery organizations according to 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 haven't 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. t
  • 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 credentialing criteria. Ability to professionally adapt to a rapidly changing environment and rule set.
  • Excellent verbal and written communication skills
  • Ability to abide by 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.

Job Requirement
  • data entry
  • Credentialing
  • Customer service
  • provider services
Reach Out to a Recruiter
  • Recruiter
  • Email
  • Phone
  • Srividhya M
  • srividhya.m@collabera.com


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