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
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