Credentialing Specialist

GI Alliance is seeking an experienced Credentialing Specialist.

Duties of this position include, but are not limited to, the following:

Position purpose

Process credentialing and re-credentialing and associated tasks in accordance with GI Alliance policies, standard operating procedures, and regulatory requirements applicable to GI Alliance provider network.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Gather and submit in appropriate format required credentialing information for assigned provider/practitioner network
• Monitor and update provider and practitioner status and associated information as appropriate
• Maintain accurate data base, tracking files, etc., for assigned provider/practitioner network
• Conduct primary source verification as appropriate
• Provide accurate and informative status reports
• Continuously track and monitor credentialing status and credentials to ensure accuracy and identify re-credentialing needs
• Ensure compliance with GI Alliance's policies and procedures as well as established regulatory and contractual requirements
• Conduct thorough review of all credentialing information to ensure compliance with policy, regulatory and contractual requirements
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Maintain provider information in online credentialing databases and system.
• Track license and certification expirations for all providers to ensure timely renewals.
• Ensure practice addresses are current with health plans, agencies, and other entities.
• Conduct research on updated state and federal regulations and policies.
• Research inquiries received from staff pertaining to provider network statuses, demographic discrepancies etc.
• Other duties as assigned
  
  

Qualifications

Qualifications

Education: High school diploma or equivalent.

Experience: Three (3) to five (5) years of credentialing experience preferred.

Additional Preferred Qualifications

• Understanding delegated credentialing requirements for the health plans.
• Understanding of hospital credentialing / appointments
• Understanding of national accrediting entities (NCQA)
• Understanding of commercial insurance, Medicare and Medicaid enrollment processes
• Understanding of credentialing terminology
• Experience with primary source verification and associated credentialing sources
  
  

Performance Requirements

• Strong presentation skills
• Excellent communication skills, both written and verbal
• Ability to work with physicians and non-physician providers in a fast-paced environment
• Proficient computer skills (Microsoft applications)
• Ability to multi-task and prioritize
• Self-motivated with initiative; willingness to learn and adopt new strategies
• Strong sense of ethics.
• GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.
  
  

Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.

NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.

No phone calls or agencies, please.

EEO/AA-M/F/disabled/protected veteran