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Company Contact Info
- Spring Hill, FL 34609
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The CSI Companies • Spring Hill, FL
Posted 2 months ago
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)
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.
- 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.