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Remain compliant with all National Committee for Quality Assurance (NCQA) changes and ensure all changes are made to the Credentialing Process. Make a DifferenceThe Credentialing Coordinator is responsible for management and implementation of the ProHealth Provider Network Credentialing Process.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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The Credentialing Coordinator is responsible for processing and completing the credentialing and re-credentialing functions of all providers by NCQA, state, and federal requirements.
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The GME Clinical Credentials Coordinator (Medical Staff Coordinator) will initiate the appointment/credentialing and reappointment/ re-credentialing process, compiling and processing data in compliance with local, regional, state, and federal accreditation requirements, under minimal supervision.
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Certified Provider Credentialing Specialist certification (CPCS) by National Committee for Quality Assurance (NCQA), preferred. This position reports to the Director of Provider Services and is responsible for full cycle credentialing of Providers and Facilities.
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Provides QI program support to QI managers and other team members, assuring PQI, Credentialing, FSR and PARS processes are compliant with regulatory or audit and accreditation requirements. The Program Manager (Quality Improvement) will provide oversight, coordination and staff support to the Quality Improvement (QI) department in the areas of National Committee for Quality Assurance (NCQA) Accreditation, as well as quality requirements for the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS.
$77,000 - $127,094 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Extensive knowledge of the regional health care provider community, current state and federal legislation and credentialing and contracting protocol, including primary source verification and NCQA (National Committee on Quality Assurance) and URAC requirements.
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The Credentialing Coordinator I is responsible for processing initial credentialing and recredentialing applications for practitioners in accordance with the contracted health plans, regulatory bodies, and NCQA standards.
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This individual is responsible for oversight of the management of the medical and behavioral health credentialing/delegation functions for Network Health Plan in accordance with the NCQA and CMS standards.
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Advanced knowledge of National Practitioner Data Bank (NPDB), NCQA, TJC, CMS and State Laws and regulations as they pertain to credentialing, Provider enrollment, and Peer Review. Exercises independent judgement in interpreting NPDB, NCQA, TJC, CMS and State Laws and regulations as they pertain to credentialing.
Full-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Collaborates with revenue cycle, contracting, IT Security, legal, regulatory, professional liability, human resources, and quality to ensure successful and timely onboarding and credentialing/privileging on the front end through provider enrollment reporting processes to ensure timely and successful commencement of claims filing.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Utilizes extensive HEDIS and coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality outcomes and STARs outcomes while not compromising payment integrity.
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Of experience in accreditation programs (i.e., NCQA, URAC and CMS programs) or 6 years of experience in accreditation programs Proficiency in accreditation program standards including NCQA, URAC and CMS Knowledge of state and federal requirements for contracting and credentialing.
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Network Health is seeking a Manager of Credentialing/Provider Informatics. Responsible for interpretation, explanation and adherence of all regulatory guidelines, bylaws, rules and regulations in the processes required for Practitioner Credentialing.
ExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Remaining compliant with and knowledgeable of rules and regulations set forth by the Health Information Portability and Accountability Act (HIPAA), Joint Commission standards, the HCQIA, the National Committee for Quality Assurance (NCQA), the Centers for Medicare and Medicaid Services, as well as state regulations— and relays this information to the necessary parties to ensure ongoing compliance organization-wide.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Current Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM) with the National Association of Medical Staff Services is preferred. Familiarity with NCQA and AAAHC accreditation standards.
ExpandApply NowActive JobUpdated 10 days ago
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