Description: A Prestigious client is currently seeking a Remote Credentialing Professional
This job will have the following responsibilities:
Perform duties related to organizational and individual provider credentialing, caregiver background checks, and delegation oversight audits for Medicare, Medicaid, and Long-Term Care Programs through accurate performance of provider data collection, verifications, documentation review, provider data reporting, and sound judgment/decision making.
Perform review of incoming provider applications for complete information from credentialing vendor and organizational providers.
Ensures that providers meet requirements of credentialing process.
Perform credentialing delegation oversight reviews of delegated provider network.
Conduct validation reviews of provider's performance of initial and ongoing provider caregiver background check audits as needed.
Prepare provider credentialing files and credentialing materials for Credentials Review Committee.
Maintains accurate, up to date provider data in database and spreadsheets.
Assist with the mailing of credentialing and creation of credentialing approval letters for communicating credentialing decisions to providers.
Respond to provider and internal inquiries regarding credentialing status
Document/track Credentialing Committee decisions and implement associated actions timely.
Coordinate and complete delegated audit reviews ensuring compliance with all regulatory guidelines; document/track results, identify compliance gaps, and implement/monitor corrective action plans for compliance gaps.
Complete caregiver background check audits; document/track results, identify compliance concerns, and implement/monitor corrective action plans for compliance gaps.
Track, synthesize, and ensure provider credentialing data integrity while maintaining efficiency.
Prepare and distribute accurate and timely reports according to department policies, documentation standards and regulatory requirements.
Perform outreach to providers for updated credentials as part of ongoing monitoring.
Assist with other credentialing and provider data projects and initiatives: Network Adequacy Review, Provider Surveys, HEDIS/5-Star, External Quality Reviews, and Performance Improvement Projects, as assigned
Looking for a candidate that has done credentialing for organizational providers, examples: hospitals, skilled nursing facilities, home health, ambulatory centers etc.
Hours: Mon-Fri; 8:00AM - 5PM Central Standard Time
Length of Contract: 6 months
Qualifications & Requirements:
Prior credentialing experience
Prior work experience and knowledge of Long Term Care, Medical, Behavioral Health, and Ancillary providers
Knowledge and experience with NCQA standards
Knowledge of Long Term Care, Medical, Behavioral Health, and Ancillary provider background requirements
At least 3-5 years managed health experience
Bachelor's degree in a healthcare, social work, quality management or related field or equivalent experience.
At least 1-3 years prior work experience with and knowledge of credentialing.
Proficiency with PC- based systems and the ability to learn new information systems and software programs required.
Ability to interact effectively with healthcare providers.
Contact: khawkins@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
