Credentialing Professional at The Judge Group Inc.

Posted in Other 12 days ago.

Location: Miami, Florida





Job Description:

Location: REMOTE

Salary: $18.00 USD Hourly - $22.00 USD Hourly

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
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