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Credentialing and Provider Enrollment Expert
2 months ago
Evolent Health is seeking a skilled Healthcare Operations Specialist to join our team in Credentialing Operations. As a key member of our team, you will play a critical role in ensuring the accuracy and completeness of provider data within our credentialing platform.
Key Responsibilities:
- Maintenance of provider data within the credentialing platform, ensuring accuracy and completeness.
- Ticket intake and triage for internal and externally submitted tickets, prioritizing tasks and projects as needed.
- Responsible for credentialing and re-credentialing files, including Type I and Type II files, in compliance with NCQA and partner-specific guidelines.
- Maintenance of working knowledge of NCQA credentialing and recredentialing guidelines, as well as partner-specific policies and procedures.
- Ongoing monthly monitoring of exclusions, sanctions, and adverse events, ensuring timely action and resolution.
- Representation of the Credentialing department in meetings and delivery of special projects, maintaining concurrent projects as assigned.
- Establishing and maintaining excellent relationships, both internally and externally, including communication with the leadership team.
- Maintenance of contractual service level and/or operational level agreements, as applicable.
- Maintenance of credentialing and provider data management systems, including CAQH, Credentialing Systems, SPayer, Symplr, and proprietary claims system and Power BI Tool.
Requirements:
- Bachelor's Degree or equivalent years of work experience.
- Minimum of two to three years' experience in the healthcare field related to credentialing, provider enrollment, provider services, and/or configuration.
- NCQA credentialing and recredentialing guidelines.
- Excellent verbal and written communication skills.
- Detail-oriented with good organizational skills.
- Ability to work in an agile space and adapt to fluctuating situations.
- Takes initiative and works independently and critically.
- Ability to time manage and reprioritize tasks/projects as appropriate.
- Microsoft Office Suite, including Word, Excel, PowerPoint, and Outlook.
- General understanding of US healthcare, Managed Care Organizations, Medicare, and/or Medicaid.
Technical Requirements:
We require that all employees have the following technical capability at their home: High-speed internet over 10 Mbps and the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact us for further assistance.
