Provider Credentialing Specialist - 100% Remote

Company: nTech Workforce
Location: Cleveland
Posted on: June 25, 2022

Job Description:

Terms of Employment

• W2 Contract-to-Hire, 6 Months
• Location: Remote
• Training: First week not to exceed 2 in person onsite training days per week in Columbia. Responsibilities
  • Analyzes and researches credentialing applications/provider contracts to verify that appropriate information has been obtained as well as handles incoming and outgoing correspondence regarding the applications. Determines the appropriate networks for participation and obtains the appropriate executed contracts. Maintains the on-line provider file and hardcopy file with updated provider information- Credentials and re-credentials providers to appropriate levels. Maintains the Application Log in accordance with state legislation.(35%)
  • Assign provider numbers and updates demographic information on the corporate database for publishing provider information in our various directories. Processes applications and updates in accordance with applicable state laws and guidelines. Maintains database for all provider information updates to support corporate mainframe system for all network provider or subscriber inquiries and is fundamental in supporting the provider special pricing process.(30%)
  • The incumbent addresses questions involving professional entities and
  • Contractual questions. Determines the nature of inquiry, researches available information and determines the proper actions required. Responds to external and internal inquiries regarding provider participation eligibility and criteria, participation status and provider file updates.(20%)
  • Prepares written responses in order to obtain incomplete or missing information. Mails appropriate provider packet when required. Mails confirmation letter to professional providers identifying necessary provider numbers for proper billing.(10%)
  • Perform other job-related duties or special projects as required.
  • Supervisory Responsibility
  • This position has no supervisory responsibilityRequired Skills & Experience
    • High school diploma with 2 years of college or commensurate work experience.
    • 3-5 years direct experience with provider contracting, credentialing or network management.
    • Credentialing or Provider file maintance experience.
    • Analytical Skills to research and analyze data.
    • Knowledge of medical terminology.
    • Strong service skills and possess ability to remain calm in stressful situations with medical professionals.
    • Experience working on a diverse team and collaborating on common issues.
    • Demonstrated success in handling large volumes of work .
    • Effective verbal and written communication skills.
    • Ability to work as a member of a team.
    • Familiarity with PC and mainframe applications.
    • Ability to organize, prioritize, and accomplish tasks within established timeframes.
    • Ability to prioritize multiple tasks and remain focused.
    • Demonstrated proficiency utilizing reference materials.
    • Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
    • Able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
    • Effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
    • Top Skills:
    • Credentialing/Data Entry/Analytical Thinking/Customer Service experience
    • Excellent communication (oral and written).
    • Knowledge in Microsoft Office and Excel required.
    • Strong organizational skills.Preferred Skills & Experience
      • Medical/Healthcare terminology and Certified Provider Credentialing Specialist.

Keywords: nTech Workforce, Cleveland , Provider Credentialing Specialist - 100% Remote, Other , Cleveland, Ohio