Healthcare - Credentialing Specialist I

Job Description: Position is fully remote. Candidates can sit anywhere in the US.
Must be able to work EST hours with a schedule of Mon-Fri 8-430 (with 30 min lunch) or 830-5 (with 30 min lunch)
Candidate must have 1-3 years of experience in basic provider data knowledge (be familiar with terminology like: NPI, License, Medicaid ID, Tax ID, etc), Credentialing experience, Provider Data Intake experience, Provider enrollment experience (to state agencies or payers). NYS Medicaid Provider/Network Requirements a plus.
Daily responsibilities will include email intake, review application for completeness, enter SharePoint tickets to MHI Cred to initiate credentialing, enter PCM iServe Tickets to initiate provider data entry to QNXT.

Summary:
Responsible for coordinating all aspects of the credentialing and primary source verification process for practitioners and health delivery organizations according to *** policy and procedures. Essential Functions: Processing Specialist Process initial and recredentialing applications from providers, meeting departmental requirements. Complete data entry of applications, reviewing them for errors prior to turning in the provider files for quality review, meeting departmental requirements. Process the minimum number of provider applications each month, meeting departmental requirements. Recredentialing/Termination Specialist Prepare and send out recredentialing groups, meeting departmental requirements. Complete 1st, 2nd and 3rd requests for recredentialing packets, meeting departmental requirements. Send report to various state plans/departments to identify any providers who havent returned their recredentialing applications or who are past-due for credentialing, meeting departmental requirements. Ongoing Monitoring/Watch Follow-up Specialist Complete follow-up for provider files on watch status, meeting departmental requirements. Ensure that follow-up occurs for the ongoing state license action monitoring reports, meeting departmental requirements. Ensure that follow-up occurs for the ongoing Medicare/Medicaid sanctions monitoring reports, meeting departmental requirements. Delegation Specialist Maintain the minimum volume of delegated provider entered into CACTUS to ensure expected levels of productivity, meeting departmental requirements. Enter data into CACTUS of delegate information should be done within required timeframes, meeting departmental requirements. Update delegate information received from delegate groups should be completed within required timeframes, meeting departmental requirements.

Knowledge/Skills/Abilities:
Ability to multi-task efficiently. Superb written and verbal communication skills. Competence with computers and data entry. Knowledge of NCQA, CMS, and *** credentialing criteria. Ability to professionally adapt to a rapidly changing environment and rule set. Excellent verbal and written communication skills Ability to abide by ***s policies Ability to maintain attendance to support required quality and quantity of work Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education: High School Diploma or equivalent Required
Experience: 1-3 years of relevant experience Required
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