Credentialing Specialist

Company: Southern California Spine
Location: El Centro
Posted on: January 17, 2023

Job Description:

Job DescriptionSalary: 18-20 per hourWould you like an exciting position as a Credentialing Specialist with growth potential with a talented group of teammates who genuinely cares about you as much as they do patient care? Then Southern California Spine is the place for you! Join a team based approach in Pain Management where you a have a direct impact in preserving life for our patients. SoCal Spine has a broad spectrum of benefits to match any competitor out there. Come work alongside our world class Doctors in our clinic outpatient setting where we focus on You everyday. We offer competitive compensation and benefits packages. Please apply!Credentialing Specialist Our company is hiring for a credentialing specialist as a part time contractor . To join our growing team, please review the list of responsibilities and qualifications.Responsibilities for credentialing specialist

• Participating in the development and implementation of credentialing processes and procedures
• Credentialing of physicians and allied health professionals
• Collecting and maintaining an accurate practitioner database and analyzing verifications
• Credentialing physicians and allied health professionals
• Collecting and maintaining an accurate practitioner database
• Credential Provider through PECOS, MEDICARE, and variety of insurance payers.
• Manage and Maintain Provider CAQH
  • Correct payments or denials if necessary and appropriate, in accordance with claim adjudication guidelines
  • Diffuse irate callers by attentive listening, maintaining a professional tone, and acknowledging their concerns by paraphrasing
  • Exercise good judgment, interpret medical claim data and contracts, and remain knowledgeable in related company policies and procedures
  • Maintain teamwork, customer service production and quality standards to assure timely, efficient and accurate call resolution
  • Maintaining compliance with regulatory and accrediting bodiesQualifications for credentialing specialist
    • Analyzing verifications
    • Establishing and maintaining a system for timely processing of credentialing and re-credentialing files in accordance with the company, CMS and NCQA policies
    • Ensuring that providers/HDOs on the company's participating panel are in compliance with the company policies and NCQA and state and federal regulatory standards
    • Maintaining current knowledge of NCQA, State and Federal requirements
    • Performing data entry in and maintaining currency of the database for tracking practitioner / HDO credentialing and re-credentialing information
    • Initiating and conducting primary source verification of provider credentialsLicensing or Certifications forCredentialing CoordinatorList any licenses or certifications required by the position:CPCS, CPMSM, NAMSS, GOLD, ECFMG, DEA, BEP/WBE/MBE, NEMT, CPMSC, CMSCEducation forCredentialing CoordinatorSome education preferred,Collage and Associate DegreeinEducation, Associates, General Education, Medical, Business, Healthcare, Health, High School Education, Health Care, Health AdministrationSkills forCredentialing CoordinatorDesired skills forcredentialing coordinatorinclude:Medical terminologyStatutes and laws relating to credentialingNCQAMicrosoft OfficeAccreditation and certification proceduresPractitioner credentialing and primary source verification of medical/dental licensurePrivilegingRelated credentialingRequirements and hospital operationsTitle 22Performing other related tasks as directed by the Associate Executive Director of Quality Management, the Credentialing Director and the Credentialing Team LeadPerform primary source verification on required elementsComplete data entry and upkeep of provider information in the credentialing databaseby Jobble

Keywords: Southern California Spine, El Centro , Credentialing Specialist, Other , El Centro, California