Credentialing Specialist

  • location: Tampa, FL
  • type: Contract
  • salary: $18.12 per hour
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job description

Credentialing Specialist

job summary:
Description:

Credentialing Specialist

JOB SUMMARY

Provider, Facility and Ancillary credentialing to include all aspects of new applicant credentialing, re-credentialing; ongoing maintenance of provider credentials; online verifications; administrative support of credentialing functions.

ESSENTIAL FUNCTIONS

Key Duties and Responsibilities

    Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing. Perform all required primary source verification. Contact hospitals, licensing agencies. malpractice carriers, and medical schools to obtain credentialing verification. Maintain and update credentialing database records. Review malpractice history. regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures. Review the CAQH system and download applications or supplemental documents as appropriate. Maintain electronic provider files. Perform outreach to providers and facilities via phone calls and fax/email correspondence. Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA. CMS. Medicaid. etc.). Perform other duties as assigned.
Additional Position Responsibilities

MINIMUM QUALIFICATIONS

    A High School or GED Required
Work Experience

    1+ year of experience in a hospital. provider or managed care setting Required 2+ years of experience in a customer service or healthcare related position Required
Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

    Demonstrated written communication skills Intermediate Demonstrated interpersonal/verbal communication skills Intermediate Ability to work as part of a team Ability to effectively present information and respond to questions from peers and management Other Knowledge of credentialing software sufficient to develop appropriate reports on all aspects of credentialing
Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred

    Microsoft Word Microsoft Excel Microsoft Outlook
 
location: Tampa, Florida
job type: Contract
work hours: 8 to 5
education: No Degree Required
experience: 1 Years
 
responsibilities:
Key Duties and Responsibilities

    Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing. Perform all required primary source verification. Contact hospitals, licensing agencies. malpractice carriers, and medical schools to obtain credentialing verification. Maintain and update credentialing database records. Review malpractice history. regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures. Review the CAQH system and download applications or supplemental documents as appropriate. Maintain electronic provider files. Perform outreach to providers and facilities via phone calls and fax/email correspondence. Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA. CMS. Medicaid. etc.). Perform other duties as assigned.
 
qualifications:
MINIMUM QUALIFICATIONS

    A High School or GED Required
Work Experience

    1+ year of experience in a hospital. provider or managed care setting Required 2+ years of experience in a customer service or healthcare related position Required
Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

    Demonstrated written communication skills Intermediate Demonstrated interpersonal/verbal communication skills Intermediate Ability to work as part of a team Ability to effectively present information and respond to questions from peers and management Other Knowledge of credentialing software sufficient to develop appropriate reports on all aspects of credentialing
 
skills: Operational improvement
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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