Credentialing Specialist
Company: LanceSoft Inc
Location: Southfield
Posted on: August 5, 2022
Job Description:
Top 3 Required Skills/Experience:
- Analyze and compare credentialing data between the national
Council for Affordable Quality Healthcare (CAQH) database and
clients 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 clientss Enterprise Credentialing
Committee.
- Must have technical ability to monitor individual workload
assigned in credentialing system and log issues for Supervisor
review.
Required Skills/Experience:
- 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 clients electronic MACESS system related
to credentialing file disposition and electronically route them to
other departments appropriately.
Preferred Skills:
- Certified Provider Credentialing Specialist (CPCS)
- Registered Health Information Technician (RHIT)
Education/Certifications:
- 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.
Keywords: LanceSoft Inc, Southfield , Credentialing Specialist, Other , Southfield, Michigan
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