Role OverviewProcess practitioner and organizational provider applications for credentialing based on State and Federal regulations and NCQA accreditation standards. Responsible for the processing of practitioner and organization/facility provider applications for credentialing and recredentialing.
What You Will Do
Resolve inquiries related to credentialing file disposition. Provide credentialing status information for group administrators, physicians and their staff, Provider Services, Customer Service and Network Development Inquiries.
Why It Might Be a Fit
May be designated by the leader to attend Credentials Committee meetings and conduct internal meetings and participate in auditing processes. Assist with special projects and job aids as needed.
Requirements
- Associate degree preferred
- Two (2) to five (5) years of work experience in provider enrollment, contracting, medical practice or hospital business office role and/or credentialing related field required
- Knowledge of related state/federal regulations, NCQA, DIFS, MDHHS and CMS standards for credentialing required
- Knowledge of CAQH required
- Excellent organizational skills with attention to detail required
- Excellent verbal and written communication skills required
- Ability to handle and prioritize multiple case files and timelines required
- Ability to work effectively independently or in a team environment required
- Intermediate knowledge of Microsoft Word, Excel, Access, PowerPoint, and internet use required
- Excellent interpersonal skills and the ability to interact with internal/external customers
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