Credentialing Specialists

PROVIDER ENROLLMENT (PE) SPECIALIST:

Applicant must live within a commutable distance to the office.

Position is in person only.

Competency

·Knowledge of payer enrollment processes and requirements, including PECOS and CAQH.

·Strong attention to detail, organizational skills, and the ability to manage multiple tasks in a fast-paced environment.

·Demonstrate accuracy, organizational and problem-solving skills.

·Excellent verbal and written communication skills.

·Ability to work independently.

·Maintains confidentiality.

Required Education and Experience

·3+ years of Provider Enrollment experience preferred.

·Must be working toward PE Certification.

·Experience with CAQH and PECOS.

·Proficient in Microsoft 365.

·Familiar with internet.

·Excellent written and verbal communication skills.

·Experience with credentialing software.

Preferred Education and Experience (Provider Enrollment Specialist III)

·Relevant education and certification a plus.

·5+ years of experience preferred.

MAIN DUTIES

·Enroll medical providers in health plans.

·Coordinates credentialing data needed for enrollment, contracting, and other related purposes.

·Creation and maintenance of CAQH Application.

·Ongoing monitoring and support of provider documentation including Kansas State or Other State Licensure, DEA, NPI, Certificate of Insurance and other documents as required by the regulatory agencies.

·Complete Third-Party Payer Applications.

·The ability to work with diverse internal and external customers.

·Terminating providers with current practice at the request of the client.

PRIMARY SOURCE VERIFICATION (PSV) SPECIALIST:

Applicant must live within a commutable distance to the office.

Position is in person only.

Competency

• Knowledge of Initial Appointment, Reappointment and Final Quality processes and requirements, including CMS, TJC, NCQA, URAC, AAAHC, ACHC (HFAP) and DNV.

• Strong attention to detail, organizational skills, and the ability to manage multiple tasks in a fast-paced environment.

• Demonstrate accuracy, organizational and problem-solving skills.

• Excellent verbal and written communication skills.

• Ability to work independently.

• Maintains confidentiality.

Required Education and Experience

• 3+ years of experience preferred.

• Must be working toward NAMSS Certification.

• Experience in working with provider database and running reports.

• Proficient in Microsoft 365.

• Familiar with internet.

• Excellent written and verbal communication skills.

• Experience with credentialing software.

Preferred Education and Experience (PSV Specialist III)

• 5+ years of experience preferred.

• Relevant education and NAMSS certification a plus.

MAIN DUTIES

• Process Initial Appointment Applications.

• Process Locum Tenens Initial Appointment Applications as Requested.

• Process Requests for Additional Privileges.

• Process Telemedicine Applications.

• Process Reappointment Applications.

• Final Quality Review.

DATA INTEGRITY (DI) SPECIALIST:

Applicant must live within a commutable distance to the office.

Position is in person only.

Competency

• Proficient in Office 365 including SharePoint.

• Database maintenance using SQL and Azure or desire and ability to learn.

• Strong attention to detail, organizational skills, and the ability to manage multiple tasks in a fast-paced environment.

• Demonstrate accuracy, organizational and problem-solving skills.

• Excellent verbal and written communication skills.

• Ability to work independently.

• Maintains confidentiality.

Preferred Education and Experience

·3+ years of relevant experience preferred.

MAIN DUTIES

·Credentialing Contact Changes.

·Initial Request for Privilege Monitoring.

·Monitor the Data Integrity through Prebuilt Reports.

·Report Assembly.

·Auditor and Process Improvements.

·Provider Enrollment Group Changes.

·SharePoint and other Apps.

·Monthly Dashboards.

·Merge Document Revisions.

·Database Maintenance Assistant.

·Database and Portal Troubleshooting.

·Updates and Upgrades to Custom Software and Portals.

·Code Maintenance and Updates.

·IT Helpdesk.

·Database Training.