Credentialing Support Jobs

Conduct thorough verification and analysis of healthcare professionals' credentials, licenses, certifications, education, and work experience.

Utilize electronic systems and databases to manage and track credentialing documents and status updates.

Minimum of 3 years’ experience working for an organization with an NCQA-accredited credentialing program

Minimum of 3 years’ experience directly assisting in the completion of an NCQA credentialing accreditation/re-accreditation survey

Strong understanding of healthcare terminology, licensing regulations, and professional qualifications

Assist with completing NCQA credentialing accreditation and re-accreditation surveys.

Verify potential and existing provider’s licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification.

Monitors and reports provider complaints and utilization management reports.

Assist management in the implementation of department process improvements.

Assist with the ongoing NCQA certification activities.

1 year job related experience

Previous experience working with files or the collection and coordination of data preferred.

Monitor and advise care centers on Licensure, DEA, Board Certification, and Malpractice Insurance expirations via Salesforce.

1 year of experience in healthcare field (Primary Source Verification, Payer, MSO office or Physician Office).

Knowledge of Salesforce is a plus.

Knowledge of Credentialing terminology is a plus.

Ability to multi-task, excellent organizational skills and planning skills required.

1 year of experience working with credentialing and/or enrollment preferred.

Excellent problem solving, time management, and work prioritization skills.

General Knowledge, Skills & Abilities

Must be able to successfully maintain multiple projects simultaneously, manage and meet multiple deadlines, be detail-oriented, and possess strong organizational skills.

Opportunities to work from home

Tuition Reimbursement Program including certifications

Experience with computer systems required, including web-based applications and Microsoft Office applications which include Outlook, Word, Excel, PowerPoint, and PDF

REMOTE | Base: $23-$26/hour + Full Benefits (medical, dental, vision, and PTO)

Manage documentation uploads critical to a client ‘activation’ in the system e.g. w-9s and licenses

Bonus: billing, coding, auditing, appeals, and medical records experience

Excellent interpersonal skills and strong communication

Enter pertinent information as a new record for each client account

Identify, retrieve, upload, and secure any documents missing from a client record

Location: Baton Rouge, Louisiana 70810 (Remote)

·Assist managers with process improvement as necessary.

·Assist managers with project planning related to contracting and credentialing workflow processes.

·Excellent written and verbal skills.

·EXCELLENT WRITTEN AND VERBAL COMMUNICATION SKILLS

·Serving as the point of contact regarding submitted application for Corporate Credentialing.

Typically requires a minimum of 3 years of experience performing hands on Credentialing Cycle Management experience.

Excellent problem solving, time management, and work prioritization skills.

General Knowledge, Skills & Abilities

Manage and maintain continuing medical education records for practitioners/providers.

Must be able to successfully maintain multiple projects simultaneously, manage and meet multiple deadlines, be detail-oriented, and possess strong organizational skills.

Clerical office, data entry, e-filing, and customer interfacing/communication experience required (preferably in a healthcare setting).

Educational, Certification And Experience Requirements

2+ years Delegated Credentialing experience (in a Healthcare Organization or hospital credentialing setting) with at least 2 years Credentialing Management experience

Certification by the National Association Medical Staff Services (NAMSS) as a Certified Professional in Medical Services Management (CPMSM), or Certified Provider

General Knowledge, Skills & Abilities

Maintain working knowledge of regulatory credentialing requirements.

Collaborate effectively with key internal and external stakeholders, including clients, compliance/legal, account management/client success, and other matrix partners, as applicable.

Excellent organizational and time management skills, ability to multitask, high attention to detail, and follow-up skills

Monitoring of all Clinician expirables to include: licenses, board certifications, professional liability insurance, hospital privileges, and payer revalidations

Minimum of 3 year’s experience in within a Credentialing or Payer Enrollment Coordinator

Provider Group or Health Plan experience required

Experience in healthcare credentialing across Behavioral Health specialties is strongly preferred

Ability to organize and prioritize work and manage multiple priorities simultaneously to meet deadlines

Certification in credentialing or healthcare quality management (e.g., CPCS, CPMSM) is a plus

Strong knowledge of credentialing standards, regulations, and best practices, including delegated credentialing requirements

Manage the end-to-end credentialing process for all behavioral health providers, including physicians, advanced practice providers (APPs), therapists, and other clinical staff

Collaborate with internal departments and external organizations to obtain and verify provider credentials, licenses, certifications, and insurance information

Maintain accurate and up-to-date provider files, ensuring compliance with all regulatory requirements and accreditation standards

Conduct thorough background checks and primary source verifications for all providers, including education, training, work history, malpractice claims, and professional references

Producing management reports regarding status of therapist community

Data entry into multiple platforms

Bachelor’s degree or equivalent work experience preferred

Excellent written and verbal communication skills

Tracking expirable documents such as licenses and malpractice insurance and working with therapists to obtain updated documents

Preparing notification letters and sending to therapists based on determinations made by the team

Follows guidelines in alignment with all health plan requirements as related to the provider certification and credentialing.

Must be able to function independently, possess demonstrated flexibility in multiple project management

Works with care centers to obtain updates to licenses, certifications, and certificates of insurance and ensures timely renewal for the same.

2+ years healthcare experience working with providers and care center staff

Demonstrated skills in problem solving and analysis and resolution

High level of attention to detail with exceptional organizational skills

Provider healthcare enrollment materials management

Data entry of provider demographic and enrollment data

Strong work ethic and self-starter, able to effectively manage multiple priorities simultaneously and adapt to change within a fast-paced business environment

Detail-oriented and able to independently manage a variety of projects and tasks simultaneously to meet the organization's business objectives.

Call center requests and triage

Document labeling, indexing, research, and routing

The Michigan Department of Education (MDE

Alternative and Remote Work Schedules:

Resume (entered or attached to the job posting)

Official copy of transcripts (when necessary)

The Office of Educator Excellence

15 and 35 personal days

Typically requires a minimum of 3 years of experience performing hands on Credentialing Cycle Management experience.

Excellent problem solving, time management, and work prioritization skills.

GENERAL KNOWLEDGE, SKILLS & ABILITIES:

Manage and maintain continuing medical education records for practitioners/providers.

Must be able to successfully maintain multiple projects simultaneously, manage and meet multiple deadlines, be detail-oriented, and possess strong organizational skills.

Clerical office, data entry, e-filing, and customer interfacing/communication experience required (preferably in a healthcare setting).

Previous experience in a production environment (non-call center).

Proficient PC skills, including MS Office products and internet search engines.

Experience with WinZip and moving/saving electronic files.

Perform daily investigative functions related to the verification of existing Equifax customers.

Review and analyze current client data based upon established guidelines.

Acquire, review, document and save all information obtained from the investigation.

Experience and knowledge in CAQH Application process

Ability to work independently in a remote environment and ability to work on a virtual team

Excellent communication skills, both verbal and written

Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems

Associate's or Bachelor's Degree in Business, Finance or a related field

Previous experience in a dental provider setting (dental assistant or front office)

Maintain records and manage provider profiles with internal credentialing software and databases

Excellent computer skills including Excel

Detail oriented with strong organizational skills

Excellent customer service skills; communicates clearly and effectively

Gather necessary information and documentation needed for credentialing direct care staff with payors

Complete re-credentialing applications upon request from payor

Demonstrate technical capability, strategic thinking, exceptional attention to detail, time management and organization, communication proficiency, leadership and teamwork

Minimum of 3 years Professional and/or Customer Service experience

Display exemplary work ethic, professionalism and interpersonal skills

Processes background checks, compliance checks, fingerprint registration, etc.

Liaises with background check vendors

Creates and maintains accounts related to the background check portion of the onboarding process

Excellent organizational and time management skills, ability to multitask, high attention to detail, and follow-up skills

Monitoring of all Clinician expirables to include: licenses, board certifications, professional liability insurance, hospital privileges, and payer revalidations

Minimum of 3 year’s experience in within a Credentialing or Payer Enrollment Coordinator

Provider Group or Health Plan experience required

Experience in healthcare credentialing across Behavioral Health specialties is strongly preferred

Ability to organize and prioritize work and manage multiple priorities simultaneously to meet deadlines