Credentialing Specialist
Found in: Resume Library US A2 - 2 weeks ago
Talent Pool: Professional/Management
This position is responsible for enrolling/credentialing the Health System?s individual providers in government (Medicare/Medicaid, etc.) and managed care plans as required by the regulations or contracts governing these plans.
Responsibilities:
Complete credentialing and re-credentialing applications for these individuals in an accurate and timely manner
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Maintain a database of physicians and non-physician practitioners (CRNAs, physician assistants, nurse practitioners, etc.) for whom the Health System is responsible for billing and/or managed care contracting. The database should contain participation status with government programs and managed care plans, effective dates of participation, re-enrollment deadlines and requirements, provider numbers and credentials
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Coordinate payor enrollment activities with internal credentialing functions performed by Medical Staff Services. Notify contracted payors of changes to provider panels
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Maintain an understanding of licensure and certification requirements in order to coordinate the enrollment process related to these activities
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Qualifications:
EDUCATION:
Bachelors, Preferred
EXPERIENCE:
3 years, Preferred
3 years experience in Provider Credentialing preferred. CACTUS experience preferred.
LICENSURE/CERTIFICATION/REGISTRY/LISTING:
REQUIRED
PREFERRED
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