Current jobs related to Credentialing Specialist - Cornelius - HEALTH NETWORK SOLUTIONS INC
-
Credentialing Specialist
6 days ago
Cornelius, Oregon, United States HEALTH NETWORK SOLUTIONS INC Full timeHEALTH NETWORK SOLUTIONS INC is seeking a skilled Credentialing Specialist to join our team. As a Credentialing Specialist, you will play a vital role in ensuring the credentialing process for healthcare providers is accurate and efficient.The estimated salary for this position is $55,000 - $65,000 per year, depending on experience. Located in the Charlotte,...
-
Credentialing Specialist
1 week ago
Cornelius, Oregon, United States HEALTH NETWORK SOLUTIONS INC Full timeJob ResponsibilitiesThe Credentialing Specialist coordinates and performs various duties required for processing applications for credentialing applicants and recredentialing existing network providers.In this role, you will work alongside the Director of Credentialing to perform activities designed to lead to a decision to accept or reject a provider's...
-
Credentialing Specialist
4 weeks ago
Cornelius, Oregon, United States HEALTH NETWORK SOLUTIONS INC Full timeJob OverviewWe are a privately-owned physician network in the Charlotte, NC Metro Area, operating in the fast-paced managed care space. Our team thrives in our family-like atmosphere, offering excellent compensation and a competitive benefit package. Most weeks, we work 37 hours.This is an exciting opportunity to join Health Network Solutions Inc as a...
-
Network Provider Credentialing Expert
7 days ago
Cornelius, Oregon, United States HEALTH NETWORK SOLUTIONS INC Full timeAbout the JobAs a Credentialing Specialist at HEALTH NETWORK SOLUTIONS INC, you will have the unique opportunity to work with a dynamic and growing company that values innovation and excellence. Your primary responsibility will be to coordinate and perform various duties related to processing applications for credentialing applicants and recredentialing...
-
Healthcare Provider Credentialing Coordinator
4 weeks ago
Cornelius, Oregon, United States HEALTH NETWORK SOLUTIONS INC Full timeJob OverviewWe are a leading physician network in the Charlotte, NC Metro Area, operating in the fast-paced managed care space. Our team strives to provide innovative services and solutions to make healthcare more accessible, effective, and affordable for everyone.Earn an estimated $62,000 - $72,000 per yearAbout the RoleThe Credentialing Specialist...
-
Cornelius, Oregon, United States HEALTH NETWORK SOLUTIONS INC Full timeJob OverviewWe are seeking a highly skilled Credentialing Specialist to join our team at Health Network Solutions Inc.This is an in-person position that requires excellent customer service skills, strong organizational abilities, and the ability to work well with individuals from diverse backgrounds.The estimated annual salary for this role is $60,000 -...
-
Healthcare Provider Network Specialist
6 days ago
Cornelius, Oregon, United States HEALTH NETWORK SOLUTIONS INC Full timeAbout the CompanyAt Health Network Solutions Inc., we operate in the fast-paced and ever-evolving managed care space. Our work is challenging and enjoyable in our family-like atmosphere. We strive to provide innovative services and solutions to make healthcare more accessible, effective, and affordable for everyone.Our Team:A diverse group of professionals...
-
Therapeutic Support Specialist
4 weeks ago
Cornelius, Oregon, United States ProCare Therapy Full timeCompany OverviewProCare Therapy is a leading provider of educational services, committed to delivering exceptional support to students and communities across the country.SalaryWe offer a competitive hourly compensation package, with estimated earnings ranging from $50-$60 per hour, depending on experience.Job DescriptionThis full-time position will involve...
-
Disability Assessment Specialist
4 weeks ago
Cornelius, Oregon, United States MRG Exams Full timeRole OverviewWe are seeking a Licensed Psychologist to perform medical assessments on United States Veterans as part of the VA's disability benefits process.This role involves reviewing behavioral health records electronically and conducting comprehensive assessments in person for each Veteran.The successful candidate will also complete Disability Benefits...
-
Veteran Disability Assessment Specialist
4 weeks ago
Cornelius, Oregon, United States MRG Exams Full timeJob OverviewWe are seeking a Licensed Psychologist to perform comprehensive assessments on United States Veterans as part of the VA's disability benefits process.In this role, you will review behavioral health records electronically through a secure Web Portal and conduct in-person assessments on each Veteran.You will also complete Disability Benefits...
-
Early Childhood Education Specialist
4 weeks ago
Cornelius, North Carolina, United States KinderCare Education Full timeAbout KinderCare Learning CompaniesFutures start here. Where first steps, new friendships, and confident learners are born.We offer a variety of early education and child care options for families. Our mission is to provide high-quality child care that supports the lifelong learning journey of children and their families.Our Teachers Make a DifferenceYou...
Credentialing Specialist
1 month ago
About Company:
We are a privately-owned physician network in the Charlotte, NC Metro Area. We operate in the fast-paced, ever-evolving, managed care space. Our work is challenging and especially enjoyable in our family-like atmosphere. We offer excellent compensation and a competitive benefit package, AND most every week, only work 37 hours. We keep our work exciting and fun, while at the same time striving to provide innovative services and solutions to make healthcare more accessible, more effective, and more affordable for everyone
Job Description:
The Credentialing Specialist coordinates and performs a variety of duties that are required for processing applications for credentialing applicants and recredentialing existing network providers. In this position, working alongside the Director of Credentialing, you will perform a series of activities designed to lead to a decision to accept or reject a provider’s application to participate as a new provider in the network and an existing provider’s application to continued participation. The credentialing process is performed in accordance with the company’s policies and procedures designed to ensure compliance with applicable laws, regulations, third-party standards, and policies.
**This is an in-person position.**
Essential Functions/Job Responsibilities:
- Sends providers credentialing and recredentialing application packets
- Ensures received application packets contain all required information
- Advises applicants of critical timelines
- Completes electronic logs that track application status and ensures adherence to various deadlines
- Establishes files for all credentialing applicants and recredentialing files for existing network providers
- Conducts credentialing activities and steps within strict predefined timelines
- Maintains knowledge of current payor, agency, and third-party requirements for credentialing providers, including, but not limited to, NCQA, URAC, and CMS standards
- Reviews credentialing and recredentialing files to ensure that they meet NCQA, URAC, and CMS standards, and payor and company requirements
- Performs primary source verification as required by NCQA, URAC, and/or CMS standards, and/or payor requirements
- Contacts providers to obtain missing or incomplete information for resolution
- Enters provider data in the electronic records database according to established procedures
- Completes verification checklists that document the completion of credentialing tasks and their corresponding timelines
- Prepares files for review by the company’s Credentialing Committee
- Notifies providers of credentialing decisions
- Ensures that credentialing is conducted in a nondiscriminatory manner
- Ensures the confidentiality of all information that is obtained during the credentialing process
- Maintain knowledge of current health plan information and agency requirements for credentialing providers
- Demonstrate and maintain the standards and requirements of the Health Insurance Portability and Accountability Act, (HIPPA); while ensuring the protection and security of personal, confidential, and identifiable information in a professional and responsible manner and carry out all measures to prevent unauthorized disclosures
- To understand and demonstrate compliance with Health Network Solutions program requirements
- Be a steward for the mission of Health Network Solutions
- Performs additional duties and functions as assigned
Education/Experience Requirements:
- High School Diploma or GED is required
- Bachelor’s degree in Business, Healthcare Administration, Communications, or a related field is preferred; however, equivalent work experience and education will be considered in lieu of a degree
- 1-2 years prior office experience in credentialing healthcare providers for a hospital, provider network, or payor
Competencies:
- Excellent customer service skills, interpersonal skills, communication skills (both oral and written) to effectively communicate with providers, providers’ staff and co-workers
- Strong organizational and time management skills
- Ability to make timely informed decisions that consider the facts, goals, constraints, and risks related to all aspects of the organization.
- Detail-oriented
- Strong critical thinking skills necessary to evaluate provider application data for accuracy and completeness
- Ability to handle situations/issues with tact and diplomacy
- Ability to work well with individuals from diverse backgrounds
- Ability to maintain confidentiality, adhere to compliance policies, and ensure that all confidential/PHI documents are kept in secure locations
- Ability to multi-task, prioritize, and adhere to timelines
- Basic computer skills including MS Office programs
Job Type: Full-time
Benefits:
We offer full benefits, including paid medical, dental, vision, and more; plus, paid holidays and paid time off; 401k (with company match); 37-hour workweek (most every week); and a great work environment
