Remote/ Hybrid Credentialing Specialist

The Credentialing Specialist evaluates, analyzes, and coordinates all aspects of the provider enrollment process. The Credentialing Specialist provides integral support to healthcare operations by ensuring timely onboarding of healthcare providers.
DUTIES:
Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, and local regulations, guidelines, policies, and standards.
Processes and reviews provider enrollment applications and Medicaid/Medicare enrollment applications.
Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
Research provider enrollment processes, when needed, to ensure applications are filled out accurately.
Review specific application/enrollment requirements including prerequisites, forms required, form completion requirements, timelines, supporting documentation, and regulations.
Establishes and maintains detailed provider relations application process (including sample applications), specific state requirements, with name, address, and phone number of the contact people at each intermediary for assigned areas
Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies, and standards.
Communicates clearly with providers, their liaisons, and Administration as needed to provide timely responses upon request on day-to-day payor enrollment issues as they arise.

QUALIFICATIONS:
Minimum of 2 years of credentialing/provider enrollment experience
Minimum of 2 years of BPO experience – must have Excellent written/verbal communication skills.
CPCS, CPMSM, or PESC certification preferred.
Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation is preferred. e.g. NPPES, CAQH, PECOS, CMS, TJC, NCQA, DNV, AAAHC, AAAASF
Ability to communicate effectively both orally and in writing.
Customer service skills.
Maintain high levels of organization while being extremely focused on detail
Ability to respond to emails timely and effectively.
Ability to use independent judgment and to manage and impart confidential information.
Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
Ability to make administrative/procedural decisions and judgments.
Demonstrated working knowledge of Microsoft Word and Excel.
Ability to learn new applications to function effectively.
Skill in establishing priorities with independent coordination of day-to-day aspects.
Advanced skills in computerized spreadsheets and database management.
OTHER SKILLS AND ABILITIES:
The use of kindness, empathy and patience when working with colleagues and patients
Attention to detail; ensuring accuracy in work
Ability to multi-task and ensure deadlines are met consistently
Ability to work as a team member, collaboratively and positively
CUSTOMER SERVICE:
Effectiveness of working with others, courtesy, tact, friendliness, enthusiasm, caring and helpful nature, comforting style.
ATTENDANCE STANDARDS
? Punctuality, attendance, scheduling of absences.
FLEXIBILITY
? Time management skills, resourcefulness, initiative.

Please answer the following questions:
1) Where are you based? Are you open to coming into Cebu Office or WFH?
2) How quickly can you start?
3) How many years of provider enrollment/credentialing experience do you have?