The successful candidate will be able to: Under the supervision of the MSO Manager of the area, responsible for credentialing and recredentialing practitioners as well as enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing credentialing applications, following up with payers, and updating and maintaining the CAQH database. As well as following applicable state and federal requirements for Medicare and Medicaid.
Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
Conducts thorough background investigation, research and primary source verification of all components of the application file.
Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
Prepares credentials file for completion other healthcare organizations, ensuring file completion within time periods specified.
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing issues as they arise.
Utilizes the Cactus credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
Monitors the initial, reappointment and expirable process for all medical staff, Allied Health Professional staff, Other Health Professional staff, and delegated providers, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Medical Staff Bylaws, Rules and Regulations, policies and procedures, and delegated contracts.
Performs miscellaneous job-related duties as assigned.
Degree in business or health related field desired. Previous experience in a Credentialing position required.
CPMSM and/or CPCS Certification by the National Association Medical Staff Services required or obtained within two years of employment.
Affiliation with the National Association Medical Staff Services and the State Association Medical Staff Services strongly encouraged.
Must have excellent organizational, time management, customer service and oral & verbal communications skills
Ability to focus on detail while responding to multiple tasks simultaneously and work effectively in a goal-oriented team environment
Must be able to maintain confidentiality of proprietary information related to all aspects of the position, hospital, medical staff and allied health professional staff
Excellent interpersonal skills, including the ability to communicate clearly, professionally, both verbally and in writing with a broad range of professionals and people of varying education and backgrounds.
Proficiency Cactus is critical.
Proficiency in data entry, typing and computer skills using a variety of software programs including Microsoft Word, Excel, Access, Outlook, PowerPoint and Cactus
Willingness to maintain a flexible work schedule as needed.
Ability to adapt to changing schedules, deadlines and demands, and a heavy workload
Competitive pay Medical, dental, and vision insurance 401k with Company match Generous paid time off Paid Holidays Tuition Reimbursement Advancement and career development opportunities
Influenza Vaccinations are a requirement for employment at CarePoint Health.
CarePoint Health is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, gender, age, religion, disability, sexual orientation, veteran status, marital status, or any other characteristic protected by law.
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