PhoenixRecruiter Since 2001
the smart solution for Phoenix jobs

Credentialing Specialist

Company: District Medical Group
Location: Phoenix
Posted on: November 23, 2021

Job Description:

About the Role:The HP Credentialing Specialist, under general supervision, work with physicians and allied health providers to facilitate the health plan credentialing / enrollment process to ensure that complete and accurate information is forwarded to health plans in a timely manner. As required by Credentialing Department policy, initiate follow-up with providers and health plans to ensure the process is continuing without unnecessary delays. Follow process to completion resulting in provider becoming contracted and receiving a specific provider identification number from each health plan in order for the billing process to commence.What You Will Do:

  • Process health plan enrollment / credentialing applications for physicians and allied health providers.
  • Review and analyze provider's returned paperwork to ensure completeness of information.
  • Identify and flag adverse information received from materials completed by the provider for the purpose of conducting special investigation; reporting this information to the Credentialing Specialist for follow-up.
  • Maintain tickler system outside of the credentialing database for follow-up of outstanding paperwork and unanswered correspondence according to schedules designed to maintain department standards for application processing time.
  • Run weekly reports from the credentialing database to determine required follow-up with providers and health plans.
  • Enter contact and action notes into credentialing database to maintain accurate record of progress with health plans.
  • Maintain credentialing database and billing database updating provider health plan identification numbers and other required database fields.
  • Organize and maintain provider health plan files and information following confidentiality guidelines.
  • Share updated information (i.e., address changes, updated licensing or certification documentation) received from the provider during the enrollment / credentialing process with the Credentialing Specialist for input into the credentialing database.
  • Employ public relations skills in a wide variety of contacts with internal and external sources for purposes of soliciting information essential to health plan enrollment / credentialing.
  • Establish and maintain a professional working relationship with providers, their outside office staff, internal staff, and health plan staff.
  • Proficient in the use of Visual Cactus (credentialing database) to enhance the health plan credentialing process and become proficient with its reporting functions.
  • Proficient in the use of Microsoft Word and Excel for Visual Cactus; NPI (National Practitioner Identification on-line access); Certifacts (American Board of Medical Specialties on-line access); State licensing agencies on-line access and Internet Explorer for other internet access.
  • Perform varied clerical / secretarial support functions
  • Perform related duties as assigned by supervisor.
  • Maintain compliance with all company policies and procedures.What You Will Bring to the Role:Experience:
    • One year of credentialing or medical administrative experience in a hospital, managed care, or physician office practice setting is preferred.Education:
      • High school diploma or equivalent
      • Certification by the National Association of Medical Staff Services in Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) preferred.Knowledge/Skills/Abilities:
        • Understanding of the basic process for enrolling / credentialing providers with health plans.
        • Understanding of each health plan's requirements for completion of all necessary paperwork needed for credentialing / enrollment process.
        • Understanding of the need of the credentialing process in the health care environment and the impact on quality patient care.
        • Basic knowledge of claims billing and/or contracting
        • Familiarity with the National Association for Quality Assurance Standards and Guidelines for MCO accreditation.
        • Problem solving and decision making
        • Understanding/compliance of HIPAA laws and regulations
        • Computer proficiency (MS Office - Word, Excel and Outlook)
        • Highly organized with excellent attention to detail and a demonstrated high regard for clerical accuracy
        • Excellent verbal and handwriting skills
        • Ability to read, extract and interpret information comparing such to established departmental policies
        • Excellent customer services and public relations skills required
        • Must be flexible and willing to work extra hours during peak workloads and deadlines
        • Ability to work as a team player with willingness to assist other team members as needed.
        • Must be able to work under pressure and meet deadlines
        • Self-motivated with the ability to work independently and to carry out assignments to completion within parameters of instructions given, established timeframes, prescribed routines, and standard accepted practices.
        • Ability to operate standard office machines and equipment, including telephones, computers, copy machines, fax machines, calculators, scanners and shredders.
        • Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
        • Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards
        • Ability to type __35__wpm
        • Experience in processing out of state Medicaid and behavioral health plan provider enrollment preferred.Physical Requirements:
          • Must be able to lift and carry up to 20 lbs
          • Must be able to talk, listen and speak clearly on telephone
          • Requires sitting and standing associated with a normal office environment.
          • Manual dexterity needed for using a computer keyboard.
          • Specific vision abilities include close vision, distance vision, depth perception and the ability to adjust focus.Environmental Working Conditions:
            • Normal office environment.
            • The noise level of the work environment is usually low to moderate.
            • Occasional overtime maybe required and/or hours may be shortened as business needs dictate.

Keywords: District Medical Group, Phoenix , Credentialing Specialist, Other , Phoenix, Arizona

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest Arizona jobs by following @recnetAZ on Twitter!

Phoenix RSS job feeds