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The Credentialing Onboarding Specialist reports to the Credentialing and Enrollment Manager and will be a key member of the Revenue Support Team. This role is primarily focused on ensuring the timely, accurate and efficient new provider onboarding and electronic billing support for all Benevis dentists and offices with payors.
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Advises and educates Provider practices in appropriate HEDIS measures and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements. Collaborates with Provider Relations to improve provider performance in areas of Quality Risk Adjustment Operations claims and encounters.
$25 - $32 an hourExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Knowledge of compliance and regulatory requirements for member and provider care and service, including CMS/ Medicare Advantage, NCQA. Clinical Trainer and Quality Assurance Specialist serves as a subject matter expert to ensure DS system clinical staff (MA, LPN,) are effectively onboarded and maintain current evidence based clinical competencies necessary for compliance with NCQA, State/Federal and other applicable regulations.
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Under general guidance form Senior Quality Practice Advisors and management, educates community physician and small provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements.
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Work with Senior leadership to support certification and accreditation processes with National Committee for Quality Assurance (NCQA)Serve as an expert in the administration and maintenance of credentialing and provider data management systems, including the Council for Affordable Quality Healthcare (CAQH), Credentialing System and proprietary claim systems.
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Ensures compliance and adherence to NCQA standards of function and responsibility relates to credentialing for CHP. Coordinates provider CHP packets and receipt of credentialing files from Med Staff Services.
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We are seeking a talented Grievance & Appeals Specialist who will be responsible for responding to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, State, and other regulations.
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Knowledge of applicable State and Federal regulations, Medicare Advantage Institutional Special Needs Plans Model of Care, STARS-Quality Program requirements and other regulations, NCQA requirements.
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CHC is designated as a federally qualified health center and a patient-centered medical home by HRSA, the Joint Commission, and NCQA, respectively. Job Description Summary:Job Description:Job Description:Urgent Care Provider (APRN or PA) - CHC of New BritainIf you are ready for a satisfying and rewarding career, join our team of diverse and motivated professionals at Community Health Center, Inc. (CHC.
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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. Monitors the progress and completion of all site visits by the provider network team to ensure completion within the established timeframe.
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SAC Health System is recognized as a Level-3 Patient-Centered Medical Home by the National Committee for Quality Assurance (NCQA). This whole-person, full-scope, team-based approach is what makes SAC Health System the provider of choice for patients.
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As a Landmark Health Provider, now a part of the Optum family, you visit your panel of patients in the comfort of their own homes. Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and MedicaidMedicare contracts and benefit systems At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
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Collaborate with Provider Relations staff for timely completion of audits and provider profiles for re-credentialing purposes Qualifications: Graduate of accredited school of nursing, RN, 2 years of experience in quality management monitoring activities and/or credentialing/ recredentialing reviews.
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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. Provider Enrollment Specialist (PESC) certificate.
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Sante Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.
$25 - $32.5 an hourExpandApply NowActive JobUpdated 6 days ago
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