Credentialing Specialist


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Job Number 53644
Posted 3/28/2018
Account EMHS
Department POPULATION HEALTH
Location Wilson Street, ME 04412
Schedule Temporary Full-Time
Shift Day
Hours 8:00 am - 5:00 pm
Job Details This is a Temporary 1 year position



JOB SUMMARY:

The Credentialing Specialist works under the supervision of the Beacon Health Credentialing Manager to perform a variety of credentialing activities and provider support activities.

Reports to: Credentialing Manager

PRIMARY RESPONSIBILITIES:

Credentialing; perform delegated Credentialing duties as assigned by the Credentialing Manager and according to existing Beacon Health (BH) policies and checklists:

· Perform duties as directed involving BH Credentialing and re-credentialing for BH providers to assure timely provider decisions and to ensure compliance with State law and NCQA guidelines;

· Enter and check for accuracy Provider data in credentialing software;

· Perform Primary Source Verification (License, Education, NPDB), expired document(s) follow-up and other activities required to complete application process;

· Entering Provider and contract information into database;

· Scan documents into appropriate electronic storage locations;

· Support monthly Credentialing Committee;

· Other Credentialing activities as directed

Network Provider Support

· Investigate and resolve questions and inquiries regarding payor status, and other network functions;

· Collaborate in the development of credentialing and other educational materials and programs for Network Providers;

· Manage questions regarding in network & in process providers; send credentialing materials and maintain all applicable files.

General

· Maintain written outlines and notes of job functions and workflow descriptions;

· Maintain an awareness of high impact/active work days;

Maintain both electronic and paper files as appropriate, track receipt of all information and maintaining

· and confidentiality;

· Other duties as required by Credentialing Manager or designee from time to time.

REQUIRED SKILLS AND ABILITIES:

Education

· A High School diploma or its equivalent is required; some college is preferred.

Experience

· A minimum of one year of related experience in a health care setting is required; three years of experience is preferred.

Setting

· Extensive amount of use of personal computers and related equipment

Interpersonal Skills

· The position involves daily contact with physicians, business executives and the public; the ability to interact in a professional and courteous manner is required.

· The ability to communicate effectively both verbally and in writing is required.

Confidentiality

· All information dealt with in this position shall be treated as the property of Beacon Health and shall be considered proprietary and confidential unless specifically deemed otherwise by the supervisor;

· All clinical information and information identifying or regarding patients and beneficiaries served by Beacon Health shall be held in the strictness confidence;

· Any breech of these and other commonly accepted guidelines for business confidentiality shall be terms for immediate termination.

Personal Computer Skills

· Facility with Microsoft programs, including WORD, ACCESS and EXCEL is required;

· Facility with use of the Internet and e-mail applications is required.

Other Skills

· A high level of initiative and sound judgment is required;

· Attention to detail is required

· Ability to manage multiple tasks in a fast paced environment is required;

· Ability to work as a member of a team is required.


Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.
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