Initiate and support the practitioner application process by sending, receiving, and analyzing practitioner documents and data import to determine completeness in preparation for payor enrollment and credentials verification process
Responsible for accurate data entry to ensure the integrity of credentialing information in applicable database(s)
Enroll providers with client payors to include Medicare, Medicaid and state and federal commercial health plans and follow up as required until process complete
Update CAQH and NPI information consistent with client practice information
Responsible for gathering, verifying evaluating highly confidential and sensitive health care practitioner credentials consistent with departmental guidelines and accreditation standards
Respond to all practitioner, client health plan and internal inquiries in a timely manner
Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed timeframe
Maintain practitioner paper and electronic data files for clients; utilizing CAQH to submit practitioner data as required to credential individual practitioners
Collaborate with participating clients in a professional manner, department manager and/or external agencies to facilitate and ensure smooth hand-off during the credentialing process
Follow up with individual practitioners and internal and external entities to resolve discrepancies identified during the credentialing process
Perform all aspects of credentialing verification, including initial credentialing and recredentialing to ensure current credentials and timely handoff and/or review and approval of practitioner files
Conduct sanctions and compliance monitoring and alert Manager of any undisclosed negative findings immediately
Participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency
Contributes to positive culture
Keep Manager informed of potential credentialing or enrollment issues
Requirements
Proficient using payor websites including but not limited to CAQH, Pecos, NPI/NPPES, Availity, NaviNet, CMS I&A
Proficiency ins using various software used for provider applications, verifying credentials and tracking verification statuses
Proficient with payor enrollment process for all levels of licensure including but not limited to MD/DO, NP, PhD, PT, OT, LCSW, OD, DDS, DPM, etc. across all specialties including medical, dental, vision, behavioral health and physical health
Knowledge of primary source verification--understand the process of verifying information directly from the original/authorized source that meets relevant regulations, accreditation requirements and compliance standards
Experience should include 3-5 years of responsibility for medical credentialing processes, policies and procedures and delegated credentialing requirements
Able to communicate clearly and concisely, both verbally and in written correspondence
Able to work well under tight deadlines and respond to rapidly changing demands and provide efficient follow up
Detail oriented with ability to recognize vital information from credentialing documents
Demonstrate problem-solving, critical thinking, and deductive reasoning skills
Ability to consistently maintain quality and production expectations
Ability to learn and use credentialing database and other related databases
Capable and comfortable dealing with sensitive and confidential information with discretion and trust
Proficiency with MS Office suite
Education & Experience
Associate's degree; or, an equivalent combination of education and/or experience
Minimum of 3 years' experience in provider credentialing in a healthcare setting
We believe in fair compensation for all of our people, which is why our pay structure takes into account
Benefits
Health insuranceDental insuranceVision insurance
Additional Information
Healthcare's helping hand.
CHG shook things up in 1979 by inventing the locum tenens staffing model. We connect doctors with patients who need their care. As the largest physician staffing firm in America, our providers treat millions of patients each year.
Our industry is growing and demand is high. This means you'll have plenty of opportunities to grow and develop in your career. Keeping healthcare healthy can be as fun as it is rewarding."
The Credentialing Specialist is responsible for credentialing and recredentialing client practitioners as well as ensuring enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing credentialing applications, performing primary source verifications and updating and maintaining credentialing database in accordance with internal policies and procedures, client health plan contracts and applicable state and federal requirements.
This is a temporary position, expected to last no more than one year.
Chghealthcare · Salt Lake City, UT