Credentialing Specialist

Harris Computer Systems

Philippines

2-4 Years

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Posted 15 hours ago
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Job Description

Daily Tasks And Responsibilities Include, But Not Limited To

Provide support and assistance for new practice setup as needed.
Assist with the completing and submitting provider enrollment applications.
Track progress of outstanding applications and communicate with provider relations representatives for follow-up ensuring enrollment completion.
Maintain accurate and current information in the provider records in credentialing software database and in provider electronic folders.
Maintain credential files in an orderly and current manner.
Provide research and administrative support for special projects.
Ensure HIPAA guidelines are respected by safeguarding protected health information in the capacity of the position and responsibilities.
Create new credentials electronic files, save provider's credentials to that file according to Global Share Filing Structure Policy, create new Practice and Provider Data Sheets.
Provider Credentials: Maintain current credentials i.e. medical licensure, DEA, COI's, etc. and set Verity CredentialStream reminders for notification of future expiration dates; maintain Provider Data Sheets with current credentialing information; maintain the credentials spreadsheet for the emergency and urgent care practices.
CAQH Re-attestation: Maintain CAQH re-attestation spreadsheet and re-attest as required updating any expired credentials.
Incoming E-mail, Faxes: Respond to requests for renewed credentials, W-9s, etc.
Maintain Electronic Files: Update provider files with current information, documentation.
Credentialing Software: Document all daily activities in Verity CredentalStream and Teamwork.
Change of Information: Submit to health plans change of information letters and W-9s regarding practice moves, adding locations, changing remit addresses.
Follow-up: Make calls or send emails to health plans and/or medical facilities to check status of applications, change of information letters, or contracts.

Important Note: This Job Description is subject to any reasonable adjustment in accordance with the changing and developing needs of the position.

Qualifications And Requirements

Preferably College Graduate or at least 2 years in College
Degrees and Courses related to Medical Field is a plus
Strong written and verbal communication skills
Ability to work effectively with minimal supervision
Ability to work with confidential information
Detail oriented
Proficient in the use of email
Highly motivated self-starter
Organized, able to set priorities and meet deadlines
Dependable and reliable
Team player being supportive of Department and Company goals and policies
Must be flexible with schedule
Previous call center experience related to Medical Accounts and Programs is a plus