Managed Care and Medical Staff Credentialing
Ø Prepare credentialing and re-credentialing applications on behalf of physicians/providers for submission to managed care companies, governmental agencies and healthcare facilities.
Ø Verify physician/provider information.
Ø Ensure database is kept accurate and updated and that all credentialing activities are in line with applicable standards. (e.g. NCQA, Joint Commission, AAAHC.)
Ø Research and solve credentialing/re-credentialing delays & issues in a timely manner.
Ø Ensure demographics/spreadsheets are prepared/complete for application processing to managed care organization specifications
Ø Coordinate all managed care credentialing activities to ensure provider participation status. Credentialing activities require substantial contact with outside agencies.
Ø Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re-credentialing to ensure requirements are met in a timely manner.
Ø Provide par/non-par analysis, submission of enrollment applications, process all re-enrollment, expirables management and CAQH re-attestations in a timely manner.
Ø Remain current on policies affecting physician/ physician extender credentials and enrollment processes.
Ø Assist with other special projects and process redesign initiatives as requested by Management or the client.
_ Maintain tracking system to ensure providers are recredentialed based on HubHealth policy.
_ Act as administrative assistant for CEO.
Special Requirements (Preferred) :
Proficient in Microsoft Office suite (i.e., Microsoft Excel, Word, etc)
Experience with provider credentialing and enrollment systems (ECHO Cloud, PECOS)
Excellent written and verbal communications skills
Job Type: Full-time
- Associates Degree or higher
- Two years in a managed care or medical staff credentialing environment
Please send resume to: email@example.com