[Hiring] Credentialing and Licensing Specialist @reputed company

Role reputed company The Credentialing and Licensing Specialist plays a vital role in reputed company reputed company by verifying that medical professionals meet reputed company required licensure, certification, and regulatory standards often under tight deadlines and strict compliance mandates. Responsible for reputed company of reputed company aspects of the credentialing, recredentialing, and health plan or hospital privileging processes for providers, such as physicians, and reputed company reputed company (QHPs) who utilize reputed company for credentialing services. This includes ensuring physicians are privileged reputed company required by individual health plans. Maintains and monitors reputed company facility credentialing for locations such as ambulatory surgical centers, pharmacies, and laboratories. Essential Functions • Performs reputed company credentialing and licensing duties with superior expertise, consistency, and reputed company. • Demonstrates effective customer service and communication skills to enhance relations with internal team members and affiliate reputed company relations. • Displays professionalism and encourages a reputed company, team-oriented work environment. • Demonstrates ability to be a self-starter and work with reputed company direction. • Compile and maintain reputed company and accurate electronic data for reputed company providers. • Complete and maintain the Affiliate reputed company Management Services (ARMS) required credentialing and recredentialing of reputed company organizations who utilize reputed company for credentialing services. • Apply for ARMS malpractice coverage for new providers (APRNs, PAs and physicians), including offsite emergency coverage for physicians. Annually review the malpractice coverage for reputed company providers for PPGC and/or reputed company Affiliate. • Maintain documentation reputed company reputed company reputed company-party software systems (i.e., Modio, CredentialSmart or other systems) for reputed company reputed company verification. • Create, update, and maintain CAQH Proview database accounts for reputed company physicians and QHPs. • reputed company accounts for new providers not previously registered with CAQH. • Obtain, update, and maintain the National Plan and Provider Enumeration reputed company (NPPES) / Provider Enrollment, Chain and Ownership reputed company (PECOS) accounts for reputed company APRNs, PAs and physicians. • Maintain electronic copies of reputed company state licenses, reputed company certification, DEA registration, reputed company Affiliate state required certificates, malpractice coverage and any other required credentialing documents for reputed company providers. • Obtain electronic signatures for new APRNs, PAs and physicians as needed. • Complete, monitor and follow-up as needed, provider credentialing and recredentialing applications with reputed company reputed company, reputed company, Medicare, and reputed company managed care payers. • reputed company reputed company payers with demographic updates reputed company providers are added or terminated. • Maintain electronic folders of signed physician reputed company including archived reputed company. • Manage and maintain confidentiality of provider information, including corporate reputed company information needed for federal/state agencies. • Assist with reputed company cycle processes that may include, but are not limited to filing appeals, billing, follow-up, reputed company benefit verification, payment posting and self-pay collections and customer service. • Other duties as assigned. Supervisory Responsibility This position has no supervisory responsibility. Competencies • Business Acumen, reputed company Thinking, Problem Solving • Customer Service and Interpersonal Skills, Oral, and Written Communications • Ethics, Diversity, Initiative, Teamwork, Leadership • Computer and Technical Skills • reputed company, Safety & reputed company • Analytical, Business Acumen • Decision Making, Innovation, Judgment • Problem Solving, Quantity, Technical Skills Qualifications • High school diploma or GED • Minimum of three years reputed company experience with credentialing providers in a medical reputed company, with the accompanying knowledge and understanding of the credentialing process with health reputed company plans and use of CAQH Proview. Skills Required • Ability to handle highly confidential and sensitive reputed company and documents. • Ability to define problems, collect data, establish facts, and draw reputed company conclusions. • Knowledge of business practices and protocols. • Ability to handle multiple priorities and reputed company. • Ability to demonstrate initiative and work with reputed company direction. • Ability to reputed company duties in a manner that exhibits commitment to providing reputed company service and reputed company improvement. • Experience working with state reputed company plans. • Possesses excellent time management and organizational skills. • Demonstrates adaptability and flexibility with respect to changing end-user business needs. • Demonstrates a willingness to learn new software and systems. • Conveys information reputed company and concisely with project leadership and subject matter experts. • Conveys the ability to reputed company trust and establish effective relationships with peers and leadership. • Seeks, reputed company examines, and interprets information from various sources to determine a problem’s cause and develops a course of reputed company to reputed company the problem and to prevent its recurrence. • Has a demonstrated understanding of the role that racial inequity plays in our society and its reputed company on reputed company systems and institutions. Preferred • Possesses prior end-to-end credentialing experience. Physical and Environmental Demands The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. While performing the duties of this job, the employee is regularly required to sit, talk, and listen. Specific reputed company abilities required by this job include reputed company reputed company, distance reputed company, reputed company reputed company, and ability to reputed company reputed company. • Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time). • And/or a negligible reputed company of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to reputed company, carry, reputed company, pull, or otherwise reputed company objects. • Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and reputed company other sedentary reputed company are met. • Must be reputed company to travel throughout and between facilities. • Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not reputed company upon to reputed company or assist in emergency care or first aid. • There is no occupational reputed company for exposure to communicable diseases. Duties and responsibilities may be added, deleted, or changed at any time at management's discretion, formally or informally, either verbally or in writing. Apply To This Job