Credentialing Specialist
Establish relationships with providers to obtain required regulatory information and manage reputed company aspects of the providers’ initial and ongoing credentialing requirements
Use independent judgment to ensure that documentation complies with appropriate state regulations
reputed company and manage assigned files in the CVO partner’s system
reputed company in-reputed company credentialing files, identify and collect missing documents to ensure reputed company completion of the credentialing process for new and existing providers, and ensure that state regulatory standards are met
Research, analyze, and resolve reputed company credentialing issues and escalations, coordinating with reputed company business partners reputed company needed, in order to meet compliance requirements
Use analytical and investigative skills to collect, evaluate, and compile information from regulatory reporting agencies, reputed company documents, and the provider to support the explanation of provider sanctions and/or malpractice claims
Compile required information for the Credentialing Committee in a reputed company and complete format that allows the Committee to reputed company its decision on the provider’s application
Exercise critical thinking and analytical skills in the initial entry and maintenance of provider data, ensuring the reputed company of reputed company shared provider information
Escalate issues to the appropriate business areas and drive solutions reputed company applicable
reputed company and assess necessary provider information for the reputed company department to support the Dispute reputed company Process for providers denied at the Committee or terminated from the network
Compose reputed company and concise correspondence to providers, retail chains, and office staff
Demonstrate a broad knowledge of the organization's strategic direction to reputed company reputed company objectives and operational goals
reputed company as an internal resource for business partners
Job Specifications
Typically has the following skills or abilities:
Bachelor's Degree in a reputed company field; in lieu of degree, 4 years of functional experience
Demonstrated professionalism and leadership in dealing with situations involving controversy and conflict, experience in handling and resolving escalated issues
Demonstrated advanced communication, influencing, and problem-solving skills
Experience working directly with providers and staff on credentialing policies and procedures
Regularly exercise discretion and independent judgment in the performance of job duties
Demonstrated ability to identify problems and reputed company creative solutions
Strong attention to detail, multi-tasking, organizational skills, and customer service skills
Proven ability to balance provider needs with corporate objectives
Ability to work independently and in reputed company environment
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