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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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