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Demonstrate a solid understanding of credentialing and NCQA guidelines around Credentialing and Provider Network. The Delegated Credentialing Coordinator is responsible for coordinating and performing all credentialing functions including pre-delegation and annual due diligence audits and monitoring of practitioner and delegated credentialing activities to ensure compliance with National Committee for Quality Assurance (NCQA), contractual agreements, and State and Federal requirements.
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The Credentialing Coordinator is responsible for management and implementation of the ProHealth Provider Network Credentialing Process. Remain compliant with all National Committee for Quality Assurance (NCQA) changes and ensure all changes are made to the Credentialing Process.
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Previous experience in a network development, provider recruitment or provider contracting. 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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Extensive knowledge of laws, rules, regulations and accreditation standards of credentialing and privileging for health plans and hospitals, including NCQA, Joint Commission, MN Dept of Health, DHS, and CMS.Demonstrated project management experience, leadership and facilitation skills, and cross-functional problem resolution skills.
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Strong knowledge of credentialing processes, regulatory requirements, and accreditation standards, such as NCQA, CMS, and The Joint Commission. Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification a plus.
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Responsible for daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources. Maintains individual provider credential files with all the appropriate documentation consistent with AAAHC and NCQA standards.
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You'll be helping us confirm to very exacting standards such as NCQA, CMS and state credentialing requirements. Help process provider credentialing and enrollment applications and re-applications including initial mailing, review and loading into the database tracking system.
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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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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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Professional certification preferred, such as Certified Professional Medical Staff Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS). Experience working with medical staff bylaws, regulatory standards, credentialing procedures and accreditation standards of The Joint Commission and National Committee for Quality Assurance (NCQA.
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As the Credentialing Manager you would be responsible for overseeing the credentialing and re-credentialing process for all providers in 170+ clinics across 30 states. Our team members are passionate about making a difference in the lives of the people we treat and are constantly striving to improve and better ourselves so that we can better support our patients and are currently searching for a Credentialing Manager to join our team.
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Collaboratively works with Managed Care to comply with, oversee and conduct the review of NCQA, CMS, and state requirements related to provider credentialing, network participation standards, and network provider standards for the delegated credentialing contracts.
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Assist Provider Data Management (PDM) team in data entry of key provider demographics and data integrity projects including but not limited to outreaching for additional details required to update CACTUS Credentialing Software's database and directory.
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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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Maintain familiarity with requirements of National Practitioner Data Bank (NPDB), State Medical Boards, the National Committee of Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), PacificSource credentialing policies and procedures and other requirements as applicable.
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