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Knowledge and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and commercial payer credentialing. Documents and tracks the status of provider enrollment applications for Medicaid, Medicare and some Commercial Payers that are not part of Delegation.
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Well versed in the use of the Cactus Database CPCS (Certified Provider Credentialing Specialist) Knowledge of Cactus a plus Knowledge or experience with credentialing processes desirable.
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Directs the credentialing process for all managed care and medical staff providers, in accordance with The Joint Commission, NCQA, URAC, and CMS accreditation standards, Federal and State Laws, and CHRISTUS Health policies.
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Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
$100,000 - $231,500 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Serves as a resource for regulatory requirements for CMS, The Joint Commission and NCQA for delegated credentialing standards. Works in collaboration with provider enrollment and the Medical Staff Office to ensure receipt and confirmation of required documentation.
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Confirm delegated provider credentialing audits performed by the delegated credentialing team for initial, annual, and interim assessments in accordance with Joint Commission, NCQA, CMS, state and federal requirements.
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Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Service Management (CPMSM) OR obtained within twelve (12) months of hire. Monitors and updates the credentialing process, including applications for appointment, reappointment, clinical privilege forms and policies to ensure compliance with Joint Commission, NCQA and CMS standards.
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Coordinates Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing status, and evaluation and appropriate actions of quality of care issues and complaints against providers.
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Maintain a thorough knowledge and meet important industry standards set forth by organizations such as NCQA, CMS, ODI, QHP, CAQH, etc. The purpose of your position is to assist the department supervisor and director with day to day operations within Networks, Credentialing and Contracting Departments.
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Position Summary:The Lead Director will be part of the Aetna Network organization and have oversight and monitoring of Medicaid network compliance requirements, focused first on Medicaid credentialing and provider data tasks.
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The Provider Resource Coordinator conducts credentialing verification activities for the centralized verification office (CVO) on behalf of the Aspirus system and private practice customers.
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4 years directly related to hospital medical staff or managed care credentialing and/or provider enrollment. Minimum 5 years of healthcare experience with 1 year directly related to hospital medical staff or managed care credentialing and/or provider enrollment.
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Set up and maintains provider information in online credentialing databases and system. Prepare provider credentialing and re-credentialing files for approval process for facility privileging requests.
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Certification in healthcare credentialing (e.g., Certified Provider Credentialing Specialist - CPCS, Certified Professional Medical Services Management - CPMSM) preferred. Thorough understanding of credentialing, delegated credentialing and licensing standards, regulations, and best practices, including those established by organizations such as NCQA, The Joint Commission, and state licensing boards.
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Knowledge of documents and their contents used in provider contracting, including applications, agreements, fee schedules, and credentialing. Understands credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements.
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provider credentialing ncqa jobs
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