Credentialing Specialist - Credentialing - Full Time - Days

ProMedica
Maumee, OH
30+ days ago
ProMedica
ProMedica
promedica.org

Job Description

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.


Summary

The Credentialing Specialist (CS) coordinates practitioner and facility applications and credentials verification programs for initial credentialing and re-credentialing processes according to standards of the National Committee on Quality Assurance.


Principal Accountabilities

  • Gathers, verifies, tracks, and maintains an audit trail of elements outlined in the Plan's credentialing and re-credentialing policies to include liaison activities with primary sources and accurate assignment of an LPU for new or established physicians.
  • Ensures that physician files are maintained with current information on licensure, DEA certificates, malpractice insurance coverage, malpractice claims experience, and other pertinent data, including the National Practitioner Data Bank reporting requirements.
  • Ensures that facility files are maintained with current information on licensure, Medicare/Medicaid certifications, and applicable accreditation.
  • Provides administrative support in the area of credentialing and re-credentialing to include accurately typed correspondence, reports, memoranda, and spreadsheets regarding provider applications for the PAC and Board of Directors meetings.
  • Assists in analyzing results of information gathered for presentation to the PAC and assists with follow-up action issues at the request of these committees.
  • Other duties as assigned.


Qualifications

  • 2 years experience in and HMO/managed care program with a working knowledge of NCQA credentialing standards required.
  • 2 – 3 years demonstrated experience in provider credentialing processes preferred.
  • Certified Provider Credentials Specialist (CPCS) certification preferred.
  • Familiarity with medical terminology required.
  • Exceptional written, telephonic, and oral communication, leadership, problem-solving, interpersonal, analytic, and organizational skills required. Ability to coordinate and organize multiple priorities.
  • Experience using Microsoft Office programs, especially Excel, Word, PowerPoint, and Access required.
  • Knowledge of Cactus and AMISYS provider databases required.
  • Demonstrated ability to maintain detailed and confidential information.


Education

  • Associate’s Degree in Health Care Administration or related field preferred.

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [email protected]

Equal Opportunity Employer/Drug-Free Workplace

Source

https://www.indeed.com/jobs

Not sure if you qualify?

Uvaro is here to help you land great jobs like this one.

Upgrade your skills

Other Jobs

Rise People

Rise is Canada’s complete people management solution that gives employers everything they need to build loyal and productive teams—all in one place. We collaborate and co-create to build solutions that completely change how companies of all shapes and sizes manage their payroll, scheduling, time tracking, group benefits, recruitment, onboarding, and more.

 
Vancouver, BC
Uvaro

1+ years of successful sales development experienced experience in B2B software or B2C services is a plus. Ability to work occasional evenings or weekends.

 
Waterloo, ON / Remote
Sysco

US0006 Sysco North Texas (Division of USA I). Personal protective equipment and masks provided. Sanitizing, disinfecting, and cleaning procedures in place.

5 hours ago
Lewisville, TX