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Credentialing Specialist in Minneapolis, MN at Pride Health

Date Posted: 10/9/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Experience:
    Not Specified
  • Date Posted:
    10/9/2018

Job Description

Credentialing Specialist

The Credentialing Specialist oversees and facilitates all credentialing related responsibilities within a large healthcare setting. This individual excels at making appropriate, independent assessments and managing multiple demanding responsibilities at once.

Duties

  • Provides highly skilled coordination and maintenance of provider credentialing, re-credentialing and membership for each entity.
  • Imports applications and enters date into the credentialing database.
  • Assists practitioners with completion of applications and required forms.
  • Processes applications following policies and NCQA standards within the established amount of time and assuring quality goals are me.
  • Obtains verifications, runs queries and reviews and assesses all verifications to determine eligibility of applicants.
  • Determines completeness of applications through Quality Review processes.
  • Maintains credentialing files to assure the DEA, Insurance and License information is not expired.
  • Initiates processing reports obtained from the NPDB and/or Boards.
  • Assists in answering main phone line and provide back-up coverage to Admin Assistant.
  • Assists in establishing policies and process improvements.
  • Assists in staff training.
  • Functions as a resource to customers on credentialing issues.
  • Assists with other duties as assigned.

Skills & Qualification

  • 1 year of administrative assistant or credentialing related experience. Would consider appropriate similar experience.
  • Experience as Administrative Assistant.
  • Knowledge in CPCS
  • Database management experience
  • Data Collection and Retrieval Skills
  • Computer Skills

Education

  • Two years of college or equivalent in medical office or health information technology.
  • CPCS or CPMSM certification through the National Association of Medical Staff Services (NAMSS).