Delegated Credentialing Specialist II - Managed Care - Days - FT

Responsibilities

• Responsible for compiling and completing physician and provider credentialing forms for appropriate payor delegations
• Initiates the verification and documentation processes for submitted applications
• Coordinates completion of physician and provider participating applications and credentialing files
• Collaborates with insurance plan providers and representatives to obtain and complete specific payer credentialing forms and applications
• Responsible for preparing and providing information to various departments and external entities
• Communicates with appropriate billing staff regarding the status of a provider's enrollment with individual payers
• Facilitates provider-related research based on suspended claims, denial issues related to the enrollment process and other feedback opportunities
• Provides requested information to authorized agencies for audits and reviews
• Ensures compliance with delegation monitoring and oversight requirements for credentialing functions
• Collaborates with the various departments to conduct the timely credentialing delegation audits
• Performs the post-audit results meetings with insurance representatives and contributes to the resolution of any audit findings
• Attends provider onboarding to obtain additional information/signatures from providers

Maintains and updates physicians and provider information in the applicable databases

• Maintains credentialing database and provider billing number tracking sheet
• Monitors and tracks license and certification expirations and renewals and provider information
• Maintains physician and provider directory information for departments and hospital
• Performs tracking and follow-up to ensure provider numbers are linked to appropriate entity and location

Education

• Required - Associates degree in Business or healthcare related field; Experience may be accepted in lieu of degree requirement
• Preferred - Bachelor's Degree in Business or Healthcare related field

Certification

• Required - Certified Provider Credentialing Specialist (CPCS) from the National Association of Medical Staff Services

Experience

• 2 years Directly related credentialing experience

Skills

• Strong verbal and written communication skills
• Data entry with minimal errors
• Database management
• Seeking solutions using appropriate methodologies