What are the responsibilities and job description for the Credentialing Specialist position at LanceSoft, Inc.?
Top 3 Required Skills/Experience:
- Analyze and compare credentialing data between the national Council for Affordable Quality Healthcare (CAQH) database and client’s credentialing system, Portico.
- Evaluate and investigate practitioner and facility state licenses for actions, sanctions and/or malpractice claims history to process accordingly with summaries created in electronic file for presentation to clients’s Enterprise Credentialing Committee.
- Must have technical ability to monitor individual workload assigned in credentialing system and log issues for Supervisor review.
- Analyze files to ensure compliance with recredentialing timelines and collaborate with Sr. Analysts to ensure alignment with the national CAQH VeriFide initiatives.
- Analyze and be familiar with Client/State Survey/Accreditation documents for Organizational Providers and request client's Quality Management onsites electronically via Portico System.
- Perform board certification and eligibility analysis and compare to rural health practitioner Excel spreadsheet to determine certification exception eligibility.
- Resolve inquiries in client’s electronic MACESS system related to credentialing file disposition and electronically route them to other departments appropriately.
- Certified Provider Credentialing Specialist (CPCS)
- Registered Health Information Technician (RHIT)
- Two (2) to five (5) years work experience in provider enrollment, contracting and/or credentialing related field required.
- Knowledge of related state/federal regulations and NCQA, DIFS and Client standards for credentialing required.
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