Medical Credentialing Specialist

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JOB OPENING

• Title:             Medical Credentialing Specialist
• Location:     Remote
• Start Date:  Immediately
• Job-Type:    Hourly (as needed)

We are seeking an experienced Medical Credentialing Specialist. The ideal candidate will have experience with preparing, submitting, and maintaining credentialing and recredentialing documentation for physicians and other healthcare providers. These documents constitute evidence of qualifying education, training, licensure, certification or registration, experience, current competence, health status, and other qualifications of health care workers. Preference will be given to those possessing experience with Military Department (MILDEP) and DHA credentialing instructions/regulations.

RESPONSIBILITIES:

• Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, Military Department (MILDEP) and DHA regulations, guidelines, policies, and standards.
• Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and Military Department (MILDEP) and DHA criteria.
• Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to Supervisor.
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
• Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
• Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards.
• Communicates clearly with providers, their liaisons, and other stakeholders as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Performs miscellaneous job-related duties as assigned.

QUALIFICATIONS:

• High School Diploma and a minimum of 2 years related experience preferred; or at least four years related experience and
• training; or an equivalent combination and work experience considered
• Working knowledge of credentialing accreditation regulations, policies, and procedures
• Certified Professional Credentialing Specialist (CPCS) certification preferred
• Healthcare: 1 year (Preferred).

KNOWLEDGE, SKILLS, AND ABILITIES NEEDED:

• Familiar with provider credentialing and recredentialing requirements
• Strong analytic computer and software skills
• Excellent interpersonal skills including excellent verbal and written communication skills
• Ability to.
• Information research skills.
• Ability to demonstrate a high degree of trust and confidentiality
• Ability to work independently and assume assigned responsibilities
• Skilled in efficiency, organization, time management, and prioritization
• Ability to be flexible and function well in a fast-paced environment/ respond to emails timely and effectively
• Ability to deal with problems involving several concrete variables in standardized situations
• Ability to communicate effectively and relate to people of different cultures
• Ability to handle confidential information

 
APPLICATION PROCESS

For more information, go to our website.  Upload your resume directly at https://french-consulting.com/careers.

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French Consulting is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements.