Credentialing Professional
The Judge Group Inc.

Job Info

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Location: REMOTE
Salary: $18.00 USD Hourly - $22.00 USD Hourly
Description: A Prestigious client is currently seeking a Remote Credentialing Professional

This job will have the following responsibilities:

• Perform duties related to organizational and individual provider credentialing, caregiver background checks, and delegation oversight audits for Medicare, Medicaid, and Long-Term Care Programs through accurate performance of provider data collection, verifications, documentation review, provider data reporting, and sound judgment/decision making.
• Perform review of incoming provider applications for complete information from credentialing vendor and organizational providers.
• Ensures that providers meet requirements of credentialing process.
• Perform credentialing delegation oversight reviews of delegated provider network.
• Conduct validation reviews of provider's performance of initial and ongoing provider caregiver background check audits as needed.
• Prepare provider credentialing files and credentialing materials for Credentials Review Committee.
• Maintains accurate, up to date provider data in database and spreadsheets.
• Assist with the mailing of credentialing and creation of credentialing approval letters for communicating credentialing decisions to providers.
• Respond to provider and internal inquiries regarding credentialing status
• Document/track Credentialing Committee decisions and implement associated actions timely.
• Coordinate and complete delegated audit reviews ensuring compliance with all regulatory guidelines; document/track results, identify compliance gaps, and implement/monitor corrective action plans for compliance gaps.
• Complete caregiver background check audits; document/track results, identify compliance concerns, and implement/monitor corrective action plans for compliance gaps.
• Track, synthesize, and ensure provider credentialing data integrity while maintaining efficiency.
• Prepare and distribute accurate and timely reports according to department policies, documentation standards and regulatory requirements.
• Perform outreach to providers for updated credentials as part of ongoing monitoring.
• Assist with other credentialing and provider data projects and initiatives: Network Adequacy Review, Provider Surveys, HEDIS/5-Star, External Quality Reviews, and Performance Improvement Projects, as assigned
• Looking for a candidate that has done credentialing for organizational providers, examples: hospitals, skilled nursing facilities, home health, ambulatory centers etc.
  

Hours: Mon-Fri; 8:00AM - 5PM Central Standard Time
Length of Contract: 6 months


Qualifications & Requirements:

• Prior credentialing experience
• Prior work experience and knowledge of Long Term Care, Medical, Behavioral Health, and Ancillary providers
• Knowledge and experience with NCQA standards
• Knowledge of Long Term Care, Medical, Behavioral Health, and Ancillary provider background requirements
• At least 3-5 years managed health experience
  
• Bachelor's degree in a healthcare, social work, quality management or related field or equivalent experience.
• At least 1-3 years prior work experience with and knowledge of credentialing.
• Proficiency with PC- based systems and the ability to learn new information systems and software programs required.
• Ability to interact effectively with healthcare providers.
  

Contact: khawkins@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

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