Skip navigation
Unable to save this job. Please try again later.

{msg}

Email this Job to Yourself or a Friend

To begin the application process, please enter your email address.

Company Contact Info

  • Spring Hill, FL 34609

Already have an account?

Sign in to apply with your saved resumes.

New to CareerBuilder?

Don't have an account? Continue as a guest!

Sorry, we cannot save or unsave this job right now.

Report this Job

Trust and Site Security Team.

Don't miss out on new jobs!

Get the latest Provider Contract Specialist jobs in Spring Hill, FL delivered directly to your inbox. You can unsubscribe at any time.

Saving Your Job Alert

Job Alert Saved!

Could not save Job Alert!

You have too many Job Alerts!

This email address has reached the maximum of 5 email alerts. To create a new alert, you will need to log into your email and unsubscribe from at least one.

Sign Up

or   Sign In Here
Password Must Contain
• 
8 to 15 characters
• 
1 uppercase letter
• 
1 number or symbol
• 
1 lowercase letter
Cancel
Create an Account with CareerBuilder to save jobs & unlock these great features
See similar job titles and skills to help you make your next move
Upload a resume and become visible to Hiring Managers and Employers
Compare Salary Information to see where you stand amongst your peers
Easily Quick Apply to jobs with just one click!

Email Send Failed!

Credentialing Specialist

The CSI Companies • Spring Hill, FL

Posted 2 months ago

Job Snapshot

Full-Time
Other Great Industries
Management

Job Description

The CSI Companies is currently seeking a Credentialing Specialist to support one of our clients in the Spring Hill, FL area.

Hours: Monday through Friday Standard Business Hours 

Pay: Depending on Experience/Education

Duration: Contract (Potential to Extend/Convert)

Job Details:

This person will be responsible for reviewing, collecting, investigating and maintaining incoming credentialing and re-credentialing applications in accordance with regulatory guidelines, maintains provider expirables and conducts required ongoing monitoring on monthly basis, conveys any discrepancies or variances to Credentialing Manager, and preserving Practitioner, Facility and Group records as necessary in credentialing software application.

Main Job Duties:

  • Reviews initial applications for completeness/discrepancies and processes by conducting primary source verification in accordance to CMS, NCQA, Federal, State and internal Policies & Procedures.
  • Upholds system integrity, loads Provider and Group information into eVips from incoming applications. Includes ongoing maintenance to ensure up-to-date provider demographics and Network participation captured.
  • Ongoing maintenance and/or verification of provider license, insurance, hospital affiliations and accreditation, to include entering current information into eVips.
  • Performs monthly, or more often as appropriate, ongoing monitoring for all Network Providers and Delegated Vendors through appropriate on-line verification sources.
  • Maintains current hard-copy and electronic credentialing files and all related documentation.
  • Responds to inquiries requesting credentialing status and follows up appropriate documentation and information pertaining to credentialing.
  • Assists the Credentialing Manager in the preparation of Credentialing Committee meetings, to include attendance. 
  • Facilitate and generate CAQH numbers for providers requesting to create new profiles.
  • Coordinates with Provider Network team and sends out applications to network providers at time of re-credentialing.
  • Participates in internal meetings and audits as directed.
  • Acts as internal support to Configuration/Claims Operations as needed.
  • Work on special projects as assigned or required.
  • Maintains a working knowledge of credentialing and contracting policies, procedures and processes.
  • Maintains confidentiality, security, and physical safety of any Provider, Plan, and PHI data.
  • Adhere to the corporate and department policies and procedures.
  • Other job duties as assigned.

Job Requirements:

  • Ability to use Outlook, Word, Excel, Adobe Acrobat Pro to produce communications, forms, spreadsheets in a proficient manner.
  • Ability to learn eVips software applications as necessary to perform job functions.
  • Commitment to maintain working knowledge and compliance with departmental policies & procedures, CMS requirements, National Committee for Quality Assurance (NCQA), as well as Federal & State guidelines.
  • Excellent interpersonal, verbal, written and customer service skills, with attention to accuracy and detail.
  • Must be personable, well organized and maintain a high level of professionalism.
  • HIPPA compliant, must respect and protect confidentiality.
  • Must have the ability to prioritize multiple tasks and work under deadlines.
  • Versatile, flexible, and a willing to work within a dynamic environment.
  • Must have the ability to follow instructions, complete tasks unsupervised and be proactive.
  • Bilingual a plus, but not required.
  • A minimum of two years’ experience in Managed Care setting, preferably in Credentialing role preferred but not required.
  • High School Graduate.            
Job ID: 44527
Help us improve CareerBuilder by providing feedback about this job: Report this Job.
CAREERBUILDER TIP
For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.
By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.
Don't miss out on new jobs like this
Get the latest jobs delivered to your inbox. Unsubscribe at any time.

Saving Your Job Alert

Job Alert Created

Well, this is embarrassing. We are having trouble saving your search. You can try again or come back at a later time.

Maximum Email Alerts

This email address has reached the maximum of 5 email alerts. To create a new alert, you will need to log into your email and unsubscribe from at least one.

More Jobs at The CSI Companies

View All Similar Jobs View All Similar Jobs