Certification in provider credentialing from either AAPC or NAMSS is highly desirable
Bachelor’s degree preferred
Five (5) years of progressive experience in credentialing and provider enrollment
Requirements:
Support business, quality and compliance for clinical Telehealth practice
Delivery of credentialing, privileging, and payer enrollment activities for clinical providers
Validate and verify provider credentials through appropriate sources
Organize and document clinical reporting and documentation review meetings
Job description
Our client, a Research, Care and Health Financing company, is looking for a Operations Coordinator for their Remote location.
Responsibilities:
The Operations Specialist supports key areas business, quality and compliance support for a clinical Telehealth practice.
Delivery of credentialing, privileging, and payer enrollment activities for clinical providers.
Administrative support of licensing and CME activities for providers
Quality program support related to clinical audits, compliance and quality outcomes
Organize, facilitate and document clinical reporting and documentation review meetings between provider staff and quality resource team.
Timely processing of initial credentialing and re-credentialing applications in accordance with regulatory requirements (NCQA, URAC, CMS, or other regulatory standards).
Validating and verifying provider credentials (licensure, DEA, specialty board, certificates, professional liability, and other required documents) through the appropriate verification sources.
Completing payer provider enrollment process, performing revalidations, maintaining CAQH profiles, NPPES registrations, provider data with payers and managing plan enrollment status in credentialing system.
Maintenance of credentialing cycles, expiration of licenses, and sanctions monitoring.
Provide and maintain a current working knowledge of credentialing standards and regulations to ensure compliance at a national level.
Review quality program requirements related to audits and ensure compliance with policies and procedures related to audit structures.
Collaborate with clinical staff to facilitate provider file reviews and clinical encounter audits, including meetings with third party reviewers.
Deliver monthly and quarterly quality and compliance reports
Requirements:
Experience 1 - 20 years
Certification in provider credentialing from either AAPC or NAMSS is highly desirable.
Bachelor’s degree preferred.
Five (5) years of progressive experience in credentialing and provider enrollment.
Knowledge of credentialing, privileging, and provider enrollment regulatory standards.
Strong understanding of credentialing databases and reporting tools and/or the ability to quickly learn them.
Strong sense of ethics and demonstrated integrity in handling confidential information.
Detail-oriented, Excellent written, verbal, and interpersonal communication skills. analytical, problem solving, decision-making and organizational skills.
Ability to work independently to accomplish objectives accurately and expeditiously.
