Delegated Credentialing Specialist

🔥 2 minutes ago

⛷️ Utah – Remote

⛷️ Utah – Remote

💵 $25 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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CHG Healthcare

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1984

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

CHG Healthcare is a company specialized in providing customized staffing solutions within the healthcare sector. By leveraging a comprehensive array of technologies and strategic consultation, CHG Healthcare enhances the capabilities of healthcare providers, hospitals, and related organizations. The company offers workforce solutions that include locum tenens, permanent placements, telehealth services, and staffing for advanced practice providers, allied health professionals, and nurses. CHG Healthcare is committed to improving the healthcare industry and supporting community needs through various outreach initiatives. With a database of over 700,000 providers, CHG is uniquely positioned to meet urgent staffing needs across various medical specialties.

📋 Description

• Initiate and support practitioner application processes by sending, receiving, analyzing, and importing practitioner documents and data • Perform accurate data entry and maintain credentialing database integrity • Enroll providers with Medicare, Medicaid, and state and federal commercial health plans • Update CAQH and NPI information consistent with client practice information • Gather, verify, and evaluate confidential practitioner credentials according to departmental guidelines and accreditation standards • Respond to practitioner, client health plan, and internal inquiries • Monitor expiring licensure, board and professional certifications, and other expirable documents • Maintain practitioner paper and electronic data files and submit practitioner data through CAQH • Collaborate with clients, department manager, and external agencies to facilitate credentialing handoffs • Resolve credentialing discrepancies with practitioners and internal and external entities • Perform initial credentialing and recredentialing verification and ensure timely file handoff or review and approval • Conduct sanctions and compliance monitoring and immediately alert the Manager to negative findings • Participate in team meetings and process improvement initiatives • Keep the Manager informed of credentialing or enrollment issues • Contribute to a positive culture

🎯 Requirements

• Proficient using payor websites including CAQH, Pecos, NPI/NPPES, Availity, NaviNet, CMS I&A • Proficiency using software for provider applications, credential verification, and tracking verification statuses • Proficient with payor enrollment processes for MD/DO, NP, PhD, PT, OT, LCSW, OD, DDS, DPM and other licensure levels across medical, dental, vision, behavioral health and physical health specialties • Knowledge of primary source verification and relevant regulations, accreditation requirements, and compliance standards • 3-5 years of responsibility for medical credentialing processes, policies, procedures, and delegated credentialing requirements • Minimum of 3 years’ experience in provider credentialing in a healthcare setting • Clear and concise verbal and written communication • Ability to work under tight deadlines and respond to changing demands • Detail-oriented with ability to identify vital information in credentialing documents • Problem-solving, critical thinking, and deductive reasoning skills • Ability to maintain quality and production expectations • Ability to learn and use credentialing and related databases • Ability to handle sensitive and confidential information with discretion and trust • Proficiency with MS Office suite • Associate’s degree; or, an equivalent combination of education and/or experience • Certified Provider Credentialing Specialist (CPCS) preferred • Provider Enrollment Specialist Certificate (PESC) preferred

🏖️ Benefits

• Flexible work schedules - including work from home options available • Award-winning training and development programs • Competitive pay