This position requires routine contact with detailed Protected Health Information (PHI) that does not require manager approval. All PHI is subject to federal and state laws and provisions.
The Credentialing Specialist is responsible for the data entry, review, validation and verification of Provider credentialing data. The specialist is responsible for ensuring the credentialing data is maintained according to all state, federal and departmental policies and procedures that make up the First Choice Health (FCH) Credentialing Program.
- Utilize internet sites to aid in the validation and research of provider credentialing data including but not limited to Web searches, NPPES NPI registry, DOH sites and Board Certification sites.
- Validate provider applications for completeness, accuracy and signatures.
- Accurate entry of provider application and credentialing status into Oracle Database.
- Review and document providers with credentialing findings per Credentialing Committee policies and procedures.
- Maintain written and verbal correspondence with federal, state and local agencies, hospitals, medical review boards and malpractice carriers regarding provider status.
- Maintain written and verbal correspondence with providers regarding status and requested additional information.
- Maintain knowledge of current National Committee for Quality Assurance (NCQA) standards.
- Maintain department metric reporting and daily staffing analysis.
- Department hours; start times cannot be prior to 6:00 am or after 11:00 PM in order to complete required daily metric. reporting and to not interfere with nightly Bridge and Diamond system support.
- Document operational policies and procedures as needed.
- Identify and document requests for information surrounding system enhancements.
- Coordinate with Credentialing Compliance as needed to ensure timely file processing.
- Coordinate with other FCH departments and Third Party Credentialing Vendor in day to day operations to answer and research provider inquiries.
- Other duties as assigned.
- AA Degree or High School diploma or equivalent, and 3-5 years of equivalent related experience in a healthcare environment
- Advanced computer skills and knowledge
- Ability to organize, manage, control work flow and meet deadlines
- Strong written, verbal and interpersonal skills
- Ability to work independently and as a member of a team
Become a First Choice Health employee and enjoy our generous benefit package. We offer competitive benefits that are much beyond the traditional basics.Click here to learn more about our competitive benefit package.
How to Apply
Please submit your resume to [email protected].
Additional information about our company may be found on our website www.fchn.com