Job Details
Description
Responsibilities :
- Perform primary source verifications of perspective providers' credentials with special emphasis on provider issues relating to malpractice claims, privileging, criminal concerns, license anomalies and discrepancies in education.
- Responsible for verifying medical licenses, criminal background checks, and other queries as needed.
- Reviews reports for disciplinary actions and follows up accordingly.
- Analyze provider applications and curriculum vitae / resumes for consistency and accuracy.
- Contacts provider peer references over the phone, email, or fax about the providers clinical performance skills.
- Contacts the provider to obtain documents and / or explanations for malpractice claims, gaps in work history / medical education, etc...
- Creates urgency with hospitals, universities, peer references, etc. through follow up calls to expedite verification completion.
- Works with the sales consultants to address and resolve incomplete information and / or documentation before submitting the file to the Risk Dept.
- Works closely with the Risk Team to ensure that the credentialing file meets the guidelines that are set in place.
- Completes work on time; proactively communicating progress and issues to relevant parties.
- Adhere to weekly and monthly KPI’s by prioritizing and meeting deadlines while maintaining quality and production expectations.
- Contributes to a positive company and team culture while building camaraderie and inspiring teamwork and trust.
- Performs other duties as assigned.
Qualifications
- Bachelor’s degree (Required)
- Proficient at Microsoft products (Excel, Power Point, Word, and Outlook)
- Experience in Salesforce and MD-Staff (Highly preferred!)
- Highly organized in managing one’s schedule, duties, workflows, and responsibilities.
- Ability to organize and prioritize work.
- Attention to detail is a must.
Qualifications
Behaviors
Motivations
Experience
Licenses & Certifications
Internal Credentialing Specialist
Works closely with the Risk Team to ensure that the credentialing file meets the guidelines that are set in place. ...
HSPD-12: Government Badging & Credentialing Specialist (Plantation, FL - REF1659I)
Citizant is a leading provider of professional IT services to the U.We seek to address some of our country's most pressing challenges in the areas of Agile application development, Enterprise Data Management, Enterprise Architecture, and Program Management support services - focusing on the U.Depart...
Medical Receptionist
Medical Receptionist - Tarpon Springs. Luke's Cataract & Laser Institute is looking to hire a full-time, medical receptionist to join our team at our Tarpon Springs location. ...
Credentialing Coordinator
Responsibilities: Processes applicant Credentialing, Coordinator, Staff, Medical, Healthcare, Business Services. This individual is assigned the responsibility of assisting the Director of medical staff services with all aspects of the credentialing and maintenance of files for medical staff and all...
Credentialing Specialist
Manage all aspects of the provider enrollment and onboarding process, including initial applications, re-credentialing, and maintaining provider information in all necessary systems. Quality review, verification, and validation of provider credentialing files before Provider Enrollment -- primary so...
Bilingual Administrative Assistant
Hollywood, FL as an Administrative Assistant:. Are you the super-star multitasker type, strong in administration skills? Our Administrative and Clerical positions support the business from multiple locations and via various functions across the nation. Serve as primary administrative support to Phar...
Remote Administrative Assistant (No Experience Required) - Earn $25/hr-$45/hr, Full-Time/Part-Time, Flexible hours
...
Credentialing Specialist II
Under the supervision of a Credentialing Supervisor/Manager, the Credentialing Specialist II is responsible for specific aspects of Credentialing and Recredentialing processing for a managed care organization, adhering to the National Committee for Quality Assurance, State and Federal regulations. A...
Medical Receptionist - Primary Care -Gulf Breeze
The Medical Receptionist I greets and registers incoming patients in the practice management system, and collects/enters demographic and insurance information with a high degree of accuracy. The Medical Receptionist I may also be responsible for processing and following up on referrals that are gene...
Administrative Assistant
The Administrative Assistant is responsible for assisting in the coordination, planning, and execution of a variety of activities and events which may include in-house, supplier, local, division, region and Company-wide. Perform administrative duties for an individual, group, or department. ...