What are the responsibilities and job description for the Credentialing Provider Specialist position at Cynet Systems?
Job Description:
Pay Range: $20hr - $25hr
Essential Functions:
Pay Range: $20hr - $25hr
Essential Functions:
- 40% Analyzes credentialing applications to perform the primary source verification of the appropriate credentials in order for a practitioner to participate in the client networks.
- Once verified, accepted and approved, determines the appropriate networks for participation and obtains the appropriate executed contracts to effectuate the professional relationship and structures the provider group accordingly.
- Reconciling delegated rosters, creating delegated provider profile configurations request for loading information into data system.
- 30% Responds to external and internal inquiries regarding provider participation eligibility and criteria, participation status, credentialing, contractual status and provider file updates.
- Direct focus on the provider experience, providing timely resolution dependable follow-up and proactive measures to ensure successful credentialing is achieved.
- Professional etiquette, communications and sound decision making is required.
- 15% Maintains the provider file, database and electronic provider files with updated provider information during processes, such as credentialing, recredentialing, demographic updates, terminations and all other provider file maintenance activities.
- 10% Responsible for identifying, analyzing and resolving immediate and existing provider file issues.
- Processes provider file inputs in accordance with applicable state laws and departmental guidelines.
- Verification of provider data and system release entered into the provider file database, ensuring a successful integration with the other corporate systems.
- 5% Prepares written responses to obtain incomplete or missing information and or communicates effectively telephonically.
- High School Diploma.
- 3 years physician credentialing experience or health insurance/managed care operations experience in a customer service, claims, billing and enrollment, or call center environment.
- Bachelor’s Degree in Business, Healthcare Administration or related field.
- Must be proficient in the use of Excel spreadsheets, and an understanding of Pivot tables.
- Excellent verbal and written communication and interpersonal skills.
- Ability to develop and maintain effective relationships with peers, physicians, and medical staff to create confidence, respect and dependability.
- Knowledge of medical terminology.
- Demonstrated proficiency utilizing reference materials and ability to follow Standard Operating procedures to reduce risk and ensure provider data accuracy and overall quality.
- Ability to understand jurisdictional requirements and the legal ramifications of the credentialing and provider file maintenance processes and interpret reasoning for performing verification and/or appropriate actions.
- Certified Provider Credentialing Specialist (CPCS) Preferred.
Salary : $20 - $25
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