Credentialing Specialist
7 days ago
13 week contract
Required:
- HSD/GED
- Flu vaccination (no declinations/no exemptions)
- Experience with physician insurance compliance/data integrity
- Proficiency (Expertise) with Excel
- Understand of HMO and Fee For Service business lines
Preferred:
- Bachelors Degree
- Experience with Epic Tapestry
Primary Duties and Responsibilities
- Reviews Provider Information Forms (PIFs) related to the MDN's managed care business operations (provider networks, HMO referrals, claims, contracts)
- Maintains the MDN's all downstream provider contract grids
- Responsible for communicating changes to downstream provider agreements to our current third party MSO
- Assists Manager in resolving discrepancies in provider contract records within EPIC's Tapestry Module and associated HMO referral system(s);
- Maintains internal rosters to mitigate inadvertent leakage resulting from incorrect listings
- Provides paneling information provided to Health Plans is accurate and timely to support Senate bill AB137
- Conducts routine audits of provider updates
- Assists with the implementation of new or amended ancillary and provider contracts.
- Works with Contracting team to determine financial implication of identified discrepancies
- Periodically audit payor reports and provider listings to ensure accurate and complete participation of MNS-represented physician networks.
Job Types: Full-time, Contract
Pay: $ $29.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Vision insurance
Work Location: In person
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