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
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.
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).
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