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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.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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I.e. in the following areas: claims, pre-delegation audits, credentialing, provider access and availability survey results, and utilization management. Knowledge of NCQA, CMS, DMHC, DHCS, California Health and Safety Codes.
ExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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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.
Full-timeExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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Conducts primary source verification for prospective providers and re-credentialing of active providers utilizing NCQA and other federal and state regulatory requirements. Resolves complex provider issues relating to credentialing, enrollment, privileging, billing and payers.
ExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Processes reports as needed to support provider education, servicing, credentialing and recruitment. Identifies system updates needed and completes research related to provider data in Onyx and Facets.
Full-timeExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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Operational ownership of the centralized credentialing process includes interfacing with new provider (Physicians & APPs), gathering paperwork from CVO or other institutional governance body, coordinating all relevant documents, authorizations, and credentials for submission processes.
Full-timeExpandApply NowActive JobUpdated 26 days ago - UpvoteDownvoteShare Job
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A Family Health Center is an NCQA recognized Patient Centered Medical Home (PCMH) Level 3. The Behavioral Health Care Manager functions as a core member of a Collaborative Care team that involves the patient's Primary Care Provider, a Psychiatric Consultant, and, when available, other mental health providers in the primary care setting.
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Maintains knowledge of current payor, agency, and third-party requirements for credentialing providers, including, but not limited to, NCQA, URAC, and CMS standards. Reviews credentialing and recredentialing files to ensure that they meet NCQA, URAC, and CMS standards, and payor and company requirements.
Full-timeExpandApply NowActive JobUpdated 19 days ago - UpvoteDownvoteShare Job
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Certified Provider Credentialing Specialist (CPCS). Assures compliance with The Joint Commission (TJC), Centers for Medicare& Medicaid Services (CMS), National Committee on Quality Assurance (NCQA), Accreditation Association for Ambulatory Health Care (AAAHC), and applicable state and federal law.
$150,100 - $195,500 a yearExpandUpdated 2 days ago - UpvoteDownvoteShare Job
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Knowledge of NCQA standards, state licensing board and other state requirements and regulations with reference to provider credentialing preferred. Oversees the daily activities associated with the efficient operation of the provider credentialing process, in cooperation with the Network Management department, Quality Management department and the Medical Director.
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The Credentialing Coordinator plays a vital role in ensuring the compliance and integrity of healthcare provider credentials, contributing to the delivery of safe and high-quality healthcare services.
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This job is responsible for performing provider credentialing, enrollment and database maintenance processing based on department and organizational policy, procedure, and standards and guidelines set forth by The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA), URAC, State and Federal Government, and health plan payors.
Full-timeExpandUpdated 2 days ago - UpvoteDownvoteShare Job
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Minimum Qualifications:Associate's Degree (Required)CMSC - Certified Medical Staff Credentialing - National Association of Medical Staff Services, CPCS - Certified Provider Credentialing Specialist - National Association of Medical Staff ServicesSPECIALIZED KNOWLEDGERequires knowledge of physician and allied health practitioner credentialing processes along with the ability to apply critical thinking skills to TJC and NCQA credentialing requirements.
Full-timeRemoteExpandUpdated 2 days ago - UpvoteDownvoteShare Job
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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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Working knowledge of Joint Commission, NCQA and CMS credentialing and privileging standards and experience with provider and health plan credentialing. Sea Mar Community Health Centers seeks an experienced Credentialing & Provider Enrollment Specialist.
$25 - $29 an hourFull-timeExpandApply NowActive JobUpdated 11 days ago
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