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Credentialing Specialist

Apex Systems San Diego Contractor
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Apex Systems has a number of full and part time positions available for Credentialing Specialist at one of our Health Care clients here in San Diego CA. 

Please read below and send your qualified resume to Email blocked - click to apply if you you are interested. 

Title: Credentialing Specialist 

Full Time Hours: 8:30 AM- 5:00 PM

Part Time Hours: 8:30 AM- 12.30PM

Responsibilities:

Scan provider credentialing information into applicable systems (e.g., Document Retrieval) to follow document management and retention procedures

Perform audit of provider file in order to ensure documentation meets state, federal, and industry standards

Verify that appropriate signatures (e.g., provider; company representatives) on contracts have been obtained and follow corporate signature procedures.

Facilitate/maintain/send correspondence (e.g., welcome letters; termination letters; rejection letters) to providers

Receive and review application and supporting documents (e.g., questionnaire; attestation form; insurance document) to determine if required and necessary information is included

Determine appropriate teams needed to provide validation of submitted information

Ensure providers have appropriate credentials (e.g., state licenses; sanctions; Medicaid/Medicare identifications; hospital affiliation; board certification; malpractice insurance)

Ensure verifications are completed within state, federal, and/or internally-mandated timeframes (e.g., NCQA; URAC; CMS)

Refer submitted application and supporting documents to internal teams

Contact and follow-up as needed with provider to obtain missing information

Provide input into policy changes or updates and/or respond to corrective action requests regarding provider application processes and related documents

Educate internal and/or external stakeholders regarding application processes (e.g., DEA guidelines; CDS guidelines)

Distribute files to applicable stakeholders (e.g., credentialing coordinators) to verify and/or enter information into appropriate systems.

Desired experience:

Demonstrate knowledge of behavioral health terminology

Demonstrate knowledge of credentialing procedures, policies, and terminology (e.g., NCQA; URAC)

Demonstrate knowledge of provider information storage and retrieval systems

Demonstrate knowledge of computer software applications (e.g., MS Office), systems (e.g., Advantage), and databases (e.g., National Practitioner Data Bank)

Demonstrate knowledge of key operating indicators (e.g., quality percentages; turnaround time).

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at 844-463-6178

 

Recommended skills

Credentialing
Medicaid
Medicare
Hospitals
Document Retrieval
Sanctions
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Job ID: 980209

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WHAT WE DO:

Apex Systems is a division of the 2nd largest IT staffing and services firm in North America. From consulting to staff augmentation, we connect top tech talent with great companies in all industries.

OUR CREDENTIALS: 

Apex earned Inavero’s Best of Staffing™ Client Diamond and Talent Awards for providing superior service to clients and job seekers, putting the company in the top 2 percent of all U.S. staffing agencies.

SUPPORTING OUR CONTRACT EMPLOYEES:

We take the time to understand a candidate’s talents and needs to ensure a good match with companies for contract, contract-to-hire, and direct hire positions. Each recruiter within Apex is focused on a specific skill area within infrastructure, applications, and project management. This focused discipline enables our local recruiters to work directly with our candidate’s and focus their talent on the right position at the right time.

WHO OUR CUSTOMERS ARE: 

We serve Fortune 500, mid-market, and emerging companies from a wide variety of industries, including communications, energy, financial services, government services, healthcare, technology, and utilities. 

WHERE WE ARE: 

Apex has branches in over 70 locations across the U.S. and Canada and more than 1,000 employees dedicated to supporting the needs of our clients and contract team members. Visit www.apexsystems.com to find a local branch or connect with an Account Manager or Recruiter.

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