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CREDENTIALING SPECIALIST

Company: Network Medical Management Inc
Location: Monterey Park
Posted on: November 18, 2021

Job Description:

SUMMARYTo assist the Credentialing Verification Organization (CVO) in the processing of initial and reappointment credentialing applications for contracted cliental.ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

  • Process initial and reappointment credentialing applications and conduct follow up as needed
  • Prepare monthly reports for peer review/credentialing committee meetings
  • Input all credentialing data into credentialing software database accurately and timely
  • Work closely with IPAs and Hospitals to ensure exceptional customer service
  • Submit new network providers to contracted health plans with required profiles
  • Maintain provider state licenses, DEA certificates, malpractice insurance and any other required credentialing documents
    • Represents the CVO while interacting with internal and external contacts
      • Remain up to date with credentialing accreditation standards with NCQA and Joint CommissionQUALIFICATIONSTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
        • Ability to analyze complex application problems and provide solutions
          • Ability to work with multiple projects and deadlines
            • Basic knowledge of current accreditation standards of Joint Commission and NCQA
            • Excellent written and verbal communication skills
            • Detail oriented and possess strong organizational skills in a fast-pace environmentEDUCATION and/or EXPERIENCE
              • High School Diploma required, BA/BS Degree preferred
              • 2-3 years' experience with managed care, hospital or CVO credentialing required
              • CPCS certification preferred#HPIND

Keywords: Network Medical Management Inc, Monterey Park , CREDENTIALING SPECIALIST, Other , Monterey Park, California

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