4/20/2014 11:45:00 PM
Responsible for credentialing activities as it relates to initial credentialing, re-credentialing, and credentials modification. Tracking of issues associated with activities necessary to maintain and document ongoing compliance.
Duties include but not limited to :
· Use CMS guidelines and internal policies and procedure to create credential provider applications for enrollment into the Medicare Part B. as well as many other insurance carriers.
· Experience with PECOS, MCS and/or FISS, NPPES, and CAQH is required.
· Leads the credentialing process by entering/logging/scanning information into credentialing system for initial, updated, add on applications and maintenance processes.
· Acts as the point person for completing and ensuring compliance and delivery of required information to insurances in a timely manner.
· Process and maintain credentialing and re-credentialing in accordance with MAR policy and procedure, CPC policy and procedures, Joint Commission standards, State and Federal Regulatory regulations.
This will include but not limited to the following verifications:
National Practitioner Data Bank OIG/GSA for Medicare/Medicaid exemption
DEA Verification Licensure
Board Certification Training verified. Residency/ Fellowship
Peer Recommendation Professional Schooling Verified
· Ensure that all credentials files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information.
· Monitor collection of all information received; follow up on missing items and/or incomplete forms, submit follow up requests for verifications as needed
· Identifies and evaluates potential red flags and works in collaboration with doctor to document the issue and doctor response.
· Advise Manager and/or Director of questionable information received and any issues identified during the processes.
· Submit closed files for audit/final review and secure missing items as identified by audit/final review
· Maintain all credentials files ensuring that all correspondence in the credentialing and reappointment process is accurately filed; is knowledgeable and current on the process and legal/regulatory requirements
· Assure confidentiality of data
· Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
· Perform other duties as assigned
· 5+ years’ experience in the managed health care industry including extensive experience with provider credentialing. This could include provider credentialing experience with health plans, on behalf of a provider organization, or with a vendor.
· Able to work with minimal supervision and works well in both individual and group environment.
· PC Skills - demonstrates proficiency in Microsoft Office (Outlook, Excel, Access, Word) applications and others as required.
- NAMSS certified as CPCS preferred but not required.
· Great communication, customer service skills
Apply Online: https://localeyesite.com/job/credentialing-specialist-0420-Plymouth+Meeting-Pennsylvania-1193
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