Job description

Position summary:

The Delegated Credentialing Specialist is responsible for performing all delegated credentialing functions for the organization in accordance with NCQA regulations.

Essential Functions:

· Develop and maintain organized system of physical and digital records pertaining to Providers.

· Supports client onboarding and set up of provider file

· Conduct primary source verification for all initial credentialing and re-credentialing files

· Work in conjunction with the Medical Director to prepare files for presentation to the Credentialing Committee

· Responsible for all pre and post Credentialing Committee activities in according with our Policies and Procedures

· Oversee quality assurance processes and reporting to ensure compliance with accreditation, federal and state regulatory requirements.

· Assist with plan audits and delegated scorecard reporting

· Other duties as assigned and required.

· Delegation oversight and plan audit activities.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required Skills:

· Excellent verbal and written communication skills

· General delegation credentialing knowledge.

· PECOS, CAQH, Adobe and Microsoft proficiency with strong Excel experience

· Must be able to manage multiple priorities in an efficient manner.

· Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices.

· Excellent understanding of the organization’s goals and objectives.

· Knowledge of applicable data privacy practices and laws.

· Highly self-motivated and directed, with keen attention to detail.

· A high level of integrity and trust.

· Knowledge of HIPAA, state and federal guidelines on security and transactions.

· Good interpersonal skills and communication with all levels of Management.

Attributes:

• Time management

• Basic research methods

• Proficient in multitasking

• Team Player

Experience and Education:

· 2 years of credentialing experience

· Knowledge of delegated credentialing a plus

Physical Requirements: Must be able to frequently move, stand, sit, bend, stoop, kneel or crouch. Must be able to lift up to 40 pounds occasionally. The noise level of the work environment is quiet to moderate.

Job Type: Full-time

Pay: $16.00 - $19.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Microsoft Office: 1 year (Preferred)
• Microsoft Word: 1 year (Preferred)
• credentialing: 1 year (Required)
• Communication skills: 1 year (Preferred)
• Microsoft Excel: 1 year (Required)
• Organizational management: 1 year (Preferred)

Work Location: In person

learninglandscape.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, learninglandscape.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, learninglandscape.com is the ideal place to find your next job.