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Credentialing Review Specialist in Jacksonville, FL at One Call

Date: 8/3/2018

Job Snapshot

Job Description

Credentialing Review Specialist

The Provider Credentialing coordinator is responsible for the background checks, applications and document follow-up.


General duties and responsibilities:

•         Maintains knowledge of current requirements for credentialing providers.

•         Prepare and/or update the provider’s application for newly affiliated and existing providers.

•         Processes applications for appointment and reappointment for One Call Care management.

•         Build knowledge base for payer requirements and forms.

•         Tracks license, and professional liability expirations for appointed providers.

•         Completes provider credentialing and re-credentialing applications for escalated cases; monitors applications and follows-up as needed.

•         Ensures recredentialing timeliness meets and/or exceeds the NCQA expectations by following up in a timely manner and escalating items as designated by policy.

•         Maintains appointment files and information in credentialing.

•         Provides excellence in customer service for internal and external customers when handling communications, whether oral or written.

•         Ensure all workflow items are completed within the set turn-around-time, meeting expectations.

•         Responsible for exceptions in committee decision follow up.



Requirements:

An Associate’s degree or other related discipline is preferred; or equivalent combination of education and experience that is required for the specific job level. 



General knowledge, skills and abilities:

•         Excellent attention to details

•         Ability to work independently, set priorities and meet deadlines with minimal supervision

•         Strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills. Experience with other Microsoft Office products.

•         Ability to communicate effectively, both orally and in writing.

•         Must be able to communicate well with a wide variety of contacts at all levels of the organization.

•         Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization.

•         Ability to maintain confidentiality, work with deadlines and manage multiple priorities.

•         Ability to maintain a high degree of professionalism and independent judgment in response to complex sensitive issues and decision-making.

•         General understanding of related accreditation and certification requirements.

•         General understanding of medical credentialing and privileging procedures and standards.

•         General understanding of medical staff policies, regulations, and bylaws and the legal environment within which they operate



Credentialing Review Coordinator I

Entry level role. Basic skills with a moderate level of proficiency.  Works on projects of limited scope Follows Standard practices and procedures in analyzing situations or data from which answers can be readily obtained. Builds stable working relationships internally. Works under close to moderate supervision with limited latitude for independent judgment. Consults with senior peers on non-complex projects to learn through experience. Typically requires a minimum of 1 year experience credentialing or provider relations experience.