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Utilize knowledge & skills set to accurately complete Medicare, Tricare, and Medicaid Programs provider enrollment application. 2 years of progressively responsible experience in a business office or managed care credentialing setting with specific experience in provider enrollment.
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USA Clinics Group is seeking a detail oriented Credentialing Specialist who is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by Medicare and Medicaid, commercial payers, hospitals, regulatory agencies.
Full-timeExpandApply NowActive JobUpdated 30 days ago - UpvoteDownvoteShare Job
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Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
$150,000 - $157,236 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Maintenance of provider enrollment processes and credentialing databases/websites/portals including CAQH, NPPES, Navinet, Availity, PECOS.Support overall Provider Enrollment Department, assist contracting department with requests as necessary and work with RCM to assist with payer issues related to credentialing.
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The Senior Payor Contract Analyst works closely with the Medical Affairs provider credentialing team, Revenue Cycle (including Hospital Physician Business Services, Coding, Patient Access, Reimbursement and other related departments), Finance department and external commercial insurance payor representatives.
$65,190 - $97,785Full-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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In this capacity, the incumbent must gather, compile, analyze and evaluate provider-specific information required for each credentialing file based on Medicare Conditions of Participation, Department of Public Health regulations, MA Board of Registration in Medicine regulations, CCA policies and procedures and other legal requirements.
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The counselor will make timelines to monitor work for completion The counselor is responsible for the timely upload of all Medicaid/ Medicare related documents to the appropriate LME/MCO provider portal to avoid lapse of authorizations The counselor is responsible for the research, corrections, and re-submission of all denied authorizations and re-authorizations to avoid loss or lapse of Medicaid coverage for the client.
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Prepares, processes, and maintains CCH location and staff or volunteer provider enrollments with Medicare, Medicaid, DentaQuest, Denver Health, Colorado Access, Beacon, TriWest, and other third-party payer plans.
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Certified Provider Credentialing Specialist (CPCS) certification preferred. Search databases for medical malpractice claims, National Provider Information, and for Medicare/Medicaid and other sanctions.
$60,000Full-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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This role requires intra-departmental communication, process management and collaboration with our Contracting, Credentialing, Provider Network Operations, and IT Staff to become a partner in the plan's strategic network growth and contracting initiatives.
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Bachelors' degree preferred; Will consider candidates with experience in medical staff services or certified Professional Medical Staff Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) in lieu of degree.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Current certification as a Nurse Practitioner by the American Nurses Credentialing Center (ANCC) or National Certification Corporation (NCC), or an equivalent Medicare/Medicaid approved certifying body, or be actively seeking certification and obtain the same in the specialty area requested within 24 months of privileges being granted at Salem Hospital.
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Minimum of one year paralegal/legal assistant experience, preferably in healthcare environment or experience in Medicare or Medicaid provider enrollment or private payer enrollment/credentialing.
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Certified Provider Credentialing Specialist (CPCS) certification - PreferredExperience working within a health plan, managed care organization, provider operated healthcare environment or Third-Party Administrator (TPA)/Business Process Outsourcing (BPO) - RequiredExtensive knowledge of computers and related software applications, such as Word, PowerPoint, Excel, Project - RequiredPrior supervisory or management experience – Required.
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For NPs: Graduate of an accredited master's degree in Nursing (MSN) program and board certified through the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC), Adult-Gerontology Acute Care Nurse Practitioners (AG AC NP), Adult/Family or Gerontology Nurse Practitioners (ACNP), with preferred certification as ANP, FNP, or GNP.
ExpandApply NowActive JobUpdated 7 days ago
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