Credentialing Specialist

1 week ago

Downers Grove, Illinois, United States Duly Health and Care Full time $46,000 - $69,000 per year

Overview
Credentialing Specialist

  • Location: Downers Grove, IL
  • Hours: Monday-Friday. 40 hours per week
  • Schedule: Hybrid 2 days in office, 3 days remote

Good enough isn't for us. Duly Health and Care's team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work.
Duly Health and Care works to understand what matters most to you. We recruit and retain team members who share a relentless passion and pride for helping others live happier and healthier lives. We invest in helping our team members develop their talents in a way that is rich in personal meaning. We invite you to join us, fulfill your purpose and make your mark
Holistic benefits designed to help our team members flourish in all aspects of their lives, including:

  • Comprehensive medical, dental, and vision benefits
  • Employer provided life and disability insurance.
  • $5,250 Tuition Reimbursement per year.
  • Immediate 401(k) match.
  • 40 hours paid volunteer time off.
  • A culture committed to community engagement and social impact.
  • Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.

Responsibilities

  • Maintains confidential research required for effective credentialing processes intended to appropriately credential for onboarding of initial applicants and reappointment activities.
  • Processes according to established legal, State and Federal agencies.
  • Prepares and reports all research and forwards to Credentials Chairperson for review and action.
  • Coordinates, tracks, and monitors flow of information to ensure the timely processing and notification of applicants in accordance to guidelines outlined in the Credentialing Policy & Procedures.
  • Processes according to established guidelines set by the Credentialing Policy and NCQA guidelines.
  • Coordinates data collection process for onboarding; tracks and monitors process and completes necessary follow-up to ensure timely processing.
  • Keeps current with all accreditation standards and legal requirements related to Credentialing ensuring that operations conform to current and appropriate regulations.
  • Acts as a liaison between the physician and payers as it relates to credentialing. Takes action when warranted on credentialing issues. Communication of findings back to the management team and providers.
  • Drafts and distributes new provider notifications to Contracted Health Plan in writing with accuracy and timely submission.
  • Follows up with each contracted health plan both in writing and/or verbally to assure acceptance can be accomplished as quickly as possible to avoid any loss of revenue, or delays in credentialing.
  • Resolves contracting issues as it pertains to credentialing, (i.e., incorrect or lack of provider or site information issues with health plan).
  • Resolves a variety of issues with payers, patients, plans and providers and responds to both written and verbal inquiries for miscellaneous information (e.g., providers' current documentation, W-9 information, status of credentialing process with specific providers, etc.)
  • Provides administrative support to the Credentialing department during audits. Monitors the process by pre-auditing credentials files.
  • Assists with inspections by regulatory authorities and/or health plans. Ensures the security and confidentiality of credentialing files.
  • Coordinates Credentialing meetings to include meeting preparation and management, development of pre-meeting agendas and after meeting follow-up activities.
  • Contact for external/internal requests and e-mails to applicant.

Qualifications

  • Minimum of 3 years equivalent experience in a managed care environment with primary focus on credentialing or accreditation activities for physicians/facilities is required.
  • Experience working with physicians and clinical staff in a medical or clinical setting
  • Knowledge of credentialing and/or accreditation requirements is required
  • Experience in telephonic, production oriented and metric driven work environment

The compensation for this role includes a base pay range of $46K- $69K/anually, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity.

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