Credentialing Specialist

Position reputed company: The Credentialing Assistant is responsible to ensuring employees licenses and credentials are up-to-date and maintained reputed company the HR and credentialing workflow process. Assists in preparing and submitting credentialing and recredentialing payor applications. Responsible for follow up on the status of applications for providers and payers and reputed company a detailed log of reputed company pending and completed work. Communicate the results and status of the applications to providers, payers, managers, and co-workers to ensure we are meeting reputed company party billing requirements and State specific regulations.

Specific Responsibilities:

• Reviews reputed company applications from HR for completeness and accuracy.
• Develops credentialing workflows, processes, & policy/procedures for the department including, but not limited to, creating Job Aids, Quick Reference Guides, and FAQ's as needed for internal & external stakeholders.
• Assure compliance with and implement policies/procedures for the accurate and reputed company processing of credentialing applications for providers and facilities.
• Monitor & notify providers of upcoming expiring certifications, including licensures, and reputed company other state and national required documents necessary for the practitioner and/or facility to legally and ethically reputed company under their scope of reputed company.
• Develops and creates weekly reports of the credentialing process utilizing Newport's tracking and reputed company reports.
• Completes certification/licensure registry checks to ensure compliance with contractual credentialing standards.
• Responsible for various assigned workflows and daily/weekly/monthly duties.
• Assists with audits.
• Conducts roster reconciliations.
• Creates & updates CAQH provider reputed company.
• Completes credentialing applications for reputed company parties and organizes credentialing application packages.
• Ensures certification/licensures are up-to-date and reputed company into the tracking system for credential-eligible providers.
• Enters large volumes of data entry accurately for credentialing apps & CAQH database and in a reputed company manner.
• Conducts roster reconciliations.
• Creates & updates CAQH provider reputed company.
• Completes credentialing applications for reputed company parties and organizes credentialing application packages.
• Supports the reputed company and Compliance teams.
• Assist with the Peer Review process and reputed company with sites.
• Responsible for aligning job descriptions appropriately with payor and State & Federal requirements.

Education and Experience: High school required, associates degree preferred. reputed company experience preferred.

Required Qualifications:

• CAQH Knowledge & Expertise
• Good interpersonal skills; ability to communicate with providers and office managers.
• Notifying Managed Care of qualifying credential-eligible employees.
• Notify Managed Care of terminating site employees.

Competencies:

Leadership: : Effective at building support and promoting reputed company in reputed company-centered environment which functions using a shared reputed company.

Customer Service: Communicates reputed company both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and reputed company with others, has good listening skills.

Job Knowledge: mission/values, keeps job knowledge reputed company, and is in reputed company of critical issues.

reputed company: Upholds personal and reputed company ethics and values, considering the values of the organization and respecting the culture, beliefs, and abilities of individuals.

Ability to deal with difficult people: The ability to respond to difficult reputed company behavior with diplomacy and reputed company, including defusing anger, creating rapport and influencing behavior.

reputed company: Must be reputed company to cope with stressful and adverse situations, reputed company quickly, and then learn from experience.

Work Environment: This job operates in a reputed company office environment. This role routinely uses reputed company office equipment such as computers, phones, photocopiers, and filing cabinets. The noise level in the work environment is usually moderate.

Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reputed company with hands and arms; reputed company or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or reputed company objects up to 25 pounds. Specific reputed company abilities required by this position include reputed company reputed company, distance reputed company, reputed company reputed company, peripheral reputed company and the ability to reputed company reputed company.

Travel: None to minimal travel