? Maintain compliance with all regulatory and accrediting institutions
? Design and maintain the development and enhancement of internal credentialing and managed care contracting processes.
? Release information to agencies and members of the public as required by law
? Monitoring and ensuring credentials documents are maintained and current.
? Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch.
? Coordinate data between internal and external systems, including licensures, CAQH, and NPPES.
? Proactively identify and resolve issues, coordinate resolutions, and identify educational opportunities.
? Maintain expertise in industry regulations (NCQA, URAC, State, Federal/CMS) and serve as the organization's regulatory subject matter expert.
? Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
? Maintains confidentiality of provider information.
? Provides enrollment with government and commercial payers.
? Monitoring and ensuring credentials documents are maintained and current.
? Data entry and follow up in credentialing software.
? Use payer credentialing systems and manage payer contracts.
? Release information to agencies and members of the public as required by law.
? Maintain a contract repository with rate sheets for revenue cycle staff.
? Develop and negotiate managed care contracts with payers.
? Monitor contract performance and compliance.
? Analyze financial and operational impact of contracts.
? Maintain relationships with managed care organizations.
? Ensure contracts align with organizational goals and regulatory requirements
? AR Calling and denial work as assigned
? Other duties as assigned.
Other Responsibilities:
? Displays a competent knowledge of CMS and insurance policy and procedures as well as Federal and State Regulations. Keeps current with available resources.
? Maintains confidentiality, proper boundaries and an ethical relationship with clients and co-workers accordingly to Company's policies.
? Ensures all provider records are maintained according to agency standards, policies and procedures.
? Completes annual educational program as required.
? Participates in the development of quality improvement activities designed to enhance agency and program services
? Performs Other Duties as Needed
Job Types: Full-time, Permanent
Pay: ?40,000.00 - ?48,000.00 per month
Benefits:
Health insurance
Leave encashment
Life insurance
Provident Fund
Application Question(s):
How many years of experience do you have as a Credentialing Specialist?
What is your current salary and your expected Salary?
Are you an immediate joiner? Please mention your notice period?
Work Location: In person
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