Credentialing Specialists

Job Description

Job Description

Come join our GROWING TEAM ! We are currently hiring additional team members across ALL teams!

Work Location: in person only in Kansas City, MO

You’ll join a team that values your ideas, invests in your growth, and believes you shouldn’t have to choose between doing excellent work and having a life outside of work. Benefits include :

· 28 days of PTO/holidays/mental health/volunteer time in the first full calendar year

· Growth Opportunities

· Cross-Training

· Career Development Program

· Team Member Appreciation

· Flexible Schedules

· Wage amount will be commensurate with experience.

PROVIDER ENROLLMENT (PE) SPECIALIST:

Applicant must live within a commutable distance to the office.

Position is in person only.

Competency

· Knowledge of payer enrollment processes and requirements, including PECOS and CAQH.

· Strong attention to detail, organizational skills, and the ability to manage multiple tasks in a fast-paced environment.

· Demonstrate accuracy, organizational and problem-solving skills.

· Excellent verbal and written communication skills.

· Ability to work independently.

· Maintains confidentiality.

Required Education and Experience

· 3+ years of Provider Enrollment experience preferred.

· Must be working toward PE Certification.

· Experience with CAQH and PECOS.

· Proficient in Microsoft 365.

· Familiar with internet.

· Excellent written and verbal communication skills.

· Experience with credentialing software.

Preferred Education and Experience (Provider Enrollment Specialist III)

· Relevant education and certification a plus.

· 5+ years of experience preferred.

MAIN DUTIES

· Enroll medical providers in health plans.

· Coordinates credentialing data needed for enrollment, contracting, and other related purposes.

· Creation and maintenance of CAQH Application.

· Ongoing monitoring and support of provider documentation including Kansas State or Other State Licensure, DEA, NPI, Certificate of Insurance and other documents as required by the regulatory agencies.

· Complete Third-Party Payer Applications.

· The ability to work with diverse internal and external customers.

· Terminating providers with current practice at the request of the client.

PRIMARY SOURCE VERIFICATION (PSV) SPECIALIST:

Applicant must live within a commutable distance to the office.

Position is in person only.

Competency

• Knowledge of Initial Appointment, Reappointment and Final Quality processes and requirements, including CMS, TJC, NCQA, URAC, AAAHC, ACHC (HFAP) and DNV.

• Strong attention to detail, organizational skills, and the ability to manage multiple tasks in a fast-paced environment.

• Demonstrate accuracy, organizational and problem-solving skills.

• Excellent verbal and written communication skills.

• Ability to work independently.

• Maintains confidentiality.

Required Education and Experience

• 3+ years of experience preferred.

• Must be working toward NAMSS Certification.

• Experience in working with provider database and running reports.

• Proficient in Microsoft 365.

• Familiar with internet.

• Excellent written and verbal communication skills.

• Experience with credentialing software.

Preferred Education and Experience (PSV Specialist III)

• 5+ years of experience preferred.

• Relevant education and NAMSS certification a plus.

MAIN DUTIES

• Process Initial Appointment Applications.

• Process Locum Tenens Initial Appointment Applications as Requested.

• Process Requests for Additional Privileges.

• Process Telemedicine Applications.

• Process Reappointment Applications.

• Final Quality Review.

DATA INTEGRITY (DI) SPECIALIST:

Applicant must live within a commutable distance to the office.

Position is in person only.

Competency

• Proficient in Office 365 including SharePoint.

• Database maintenance using SQL and Azure or desire and ability to learn.

• Strong attention to detail, organizational skills, and the ability to manage multiple tasks in a fast-paced environment.

• Demonstrate accuracy, organizational and problem-solving skills.

• Excellent verbal and written communication skills.

• Ability to work independently.

• Maintains confidentiality.

Preferred Education and Experience

· 3+ years of relevant experience preferred.

MAIN DUTIES

· Credentialing Contact Changes.

· Initial Request for Privilege Monitoring.

· Monitor the Data Integrity through Prebuilt Reports.

· Report Assembly.

· Auditor and Process Improvements.

· Provider Enrollment Group Changes.

· SharePoint and other Apps.

· Monthly Dashboards.

· Merge Document Revisions.

· Database Maintenance Assistant.

· Database and Portal Troubleshooting.

· Updates and Upgrades to Custom Software and Portals.

· Code Maintenance and Updates.

· IT Helpdesk.

· Database Training.