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Posted: 19-Sep-23
Location: Irving, Texas
Salary: Open
Categories:
Internal Number: 11559806
Summary:
Responsible for leading, coordinating, monitoring, and maintaining the credentialing expireables process. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of data within the credentialing database.
- Conducts thorough investigation, research, and primary source verification of all expireables.
- Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.
- Prepares and sends monthly expireables reports to clients.
- Responds to inquiries from other healthcare organizations, interfaces with internal/ external customers on day-to-day expireables issues as they arise.
- Meets weekly performance metrics which includes: amount of expireables completed and data integrity.
- Utilizes and maintains the credentialing database, optimizing efficiency, and performs queries, reports, and document generation.
- Monitors the initial, reappointment, and expireables process for practitioners, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, Federal/State), bylaws, policies/procedures, and delegated agreements
- Maintains strict confidentiality of all data and information.
- Performs miscellaneous job-related duties as assigned.
Requirements:
- High School Diploma or GED
- Minimum of at least one (1) year experience related to hospital or managed care credentialing.
- Certified Provider Credentialing Specialist (CPCS) preferred
Work Type:
Full Time
