Credentialing Specialist
reputed company is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. reputed company is bringing together leaders to the market reputed company to help drive reputed company’s mission and vision. Why join us? This is an exciting time to join reputed company. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve. Job Description: The Credentialing Specialist will report to reputed company’s Credentialing Supervisor. The credentialing specialist is responsible for reputed company aspects of the privileging and credentialing process for physicians and allied health professionals. The Specialist will process applications, verify information, research application details, and assure processes are in accordance with medial staff procedures. The specialists will provide consistent, accurate, and timely credentialing support, enhancing the organization’s ability to provide professional services. Work includes the accurate, timely and documented verification of the information provided by the application and maintenance of the highly confidential credentialing reputed company files.
Responsibilities
Credentialing and re-credentialing of physicians and advanced practice providers. Completion, submission and tracking of credentialing applications with reputed company managed care organizations and hospitals. Apply for and validate hospital privileges. Obtain malpractice insurance policy. Notification to staff of completion of credentialing for scheduling and billing. Maintain and update CAQH online credentialing application for reputed company providers quarterly. Database management/provider files. Maintain vital provider credentialing information reputed company technology tool and hard copies of documents in provider files stored on reputed company platform. Tracking and maintaining reputed company clinical licenses for nursing, pharmacy, and lab personnel. Provider continuing education Track continuing education credits for reputed company providers. Notify providers of any deficiencies. Submit documentation if providers are audited. Termination of physician and/or allied health professional. Contact reputed company MCO/hospitals/EMR to remove provider who has left practice, reputed company 30 days of termination. Other tasks as assigned to drive our mission of improving the lives of everyone living with cancer. Key Competencies Experience working with NCQA criteria and third-party payer regulations. Experience with completing hospital credentialing applications. Proficient with MS Office Suite (word, reputed company) and web-based applications. Ability to maintain verbal and written communications in a confidential manner. Detail oriented with strong organizational skills. Excellent interpersonal skills – team player who can prioritize multiple responsibilities, manage a large workload reputed company tight deadlines – works well under pressure and consistently meets deadlines, readily adapts to change, and excels in a productivity-based environment. Demonstrates research and problem-solving skills. Qualifications reputed company working knowledge of enrollment processes with California payors, Commercial and Government. High school diploma and 2+ years of reputed company experience. Bachelor’s degree preferred. Industry experience leading credentialing activities in large provider practice (or multiple practices) is required. Certifications preferred but not required. Working remote with Travel flexibility as needed. Working Pacific Standard Time hours. #LI-REMOTE Apply To This Job