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Healthcare Consultant

Sunrise Full-Time
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Title: Healthcare Consultant 1

Location:  Terrace Sunrise FL 33323 United States

Duration: 0-6 month(s)

Qualifications:

• Reviews, analyzes, evaluates, validates provider/producer information against business/credentialing requirements and maintains information in Credentialing Management data bases.

• Reviews (re)credentialing data for completeness, accuracy and conducts research pertaining to missing data.Performs accurate and timely baseline demographic transaction updates in provider/producer system applications. Analyzes data to identify variances in information furnished by providers/producers against primary verification sources.

• Utilizes systems to maintain credential files, Quickbase and QNXTto track queries, documentation of phone calls, correspondence, completed applications, and outcomes.

• Contacts providers/producers to clarify and resolve data quality issues.

• Identifies potential risk situations, collects pertinent information and completes investigation.

• Reports results of credentials findings and document further action needed.

• Protects the confidentiality and integrity of provider/producer data files.

• Conducts and manages ongoing review of provider/producer compliance to contract requirements. Researches, investigates, approves and coordinates resolution of business exceptions with internal and external constituents. Identifies and appropriately escalates data transaction and credentialing issues that might potentially have significant adverse impact on service levels. Monitors and reports data elements for quality against standards. Manages incoming requests for provider/producer application and status requests, utilizing systems to determine eligibility for network participation. Performs recredentialing application management process for all outstanding applications at risk of non-compliance. Utilizes data systems to access information to respond to customer service call line questions maintaining service call TAT, ASA and high quality customer satisfaction goals.

Education:  

• Additional Job Details:

•  College degree or equivalent work experience preferred. High School Diploma or G.E.D. Ability to work reliably, prudently and tactfully with confidential information. Proficient computer skills, including proficiency in Microsoft Word and Excel.Strong verbal and written communication skills.



Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.

Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.)


Education:  

• Additional Job Details:

•  College degree or equivalent work experience preferred. High School Diploma or G.E.D. Ability to work reliably, prudently and tactfully with confidential information. Proficient computer skills, including proficiency in Microsoft Word and Excel.Strong verbal and written communication skills.










Skills required

Analysis
Data Analysis
Forecasting
Finance
Financial Analysis
Accounting
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Job ID: 321342

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