The Provider Credentialing Specialist will review, approve, deny or return applications submitted by providers who want to provide services covered under commercial and/or Medicaid insurance plans, within the appropriate standards and timelines established by state and federal regulatory and accreditation agencies. If working with Medicaid providers, then adhering within the appropriate standards and timelines established by the Centers for Medicare and Medicaid Services (CMS).
Minimum of one year of recent experience as a Credentialing Specialist in a full cycle credentialing role
Solid knowledge of NCQA (National Committee for Quality Assurance) or URAC (Utilization Review Accreditation Commission) and state credentialing requirements
Strong computer and telephone multitasking skills including: the ability to effectively search for and type information on the computer, navigate through multiple windows and screens quickly, and inputting information accurately while keeping pace with the call
Excellent analytical and problem-solving skills with the ability to make independent decisions
Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
Requires excellent verbal and written communication skills
Ability to remain focused and productive each day though tasks may be repetitive Responsibilities:
Credential/re-credential providers (physicians, healthcare delivery organizations, or pharmacies)
Monitor collection of all information received, follow up on missing items and/or incomplete forms, and submit follow up requests for verifications as needed
Process, track, and file credentialing applications according to established standards and ensure that the credentialing database is updated and maintained
Respond to internal and external inquiring regarding credentialing status
Submit closed files for audit/final review and secure any missing items identified during the audit/final review process Preferred Qualifications:
Previous successful work at home experience
About the Company
BroadPath provides specialized business, compliance, and technology services to healthcare payers and providers in commercial and government sectors.
We focus solely on healthcare, so our team understands our clients' issues in a way few others can. And since we work with the country's top healthcare organizations, we have unique insight into the industry's best practices and of the dynamics and regulations affecting operations and outcomes.
Employment Type: Permanent
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