Address
Form of work- Complete credentialing and recredentialing of practitioners and organizational providers based on State and Federal regulations, accreditation standards and Client business requirements.
- Provide analytical support, problem identification and facilitate resolutions to complete credentialing processes utilizing Client's electronic Credentialing system.
- Analyze and compare credentialing data between the national Council for Affordable Quality Healthcare (CAQH) database and Client's credentialing system, Portico.
- Evaluate and investigate practitioner and facility state licenses for actions, sanctions and/or malpractice claims history to process accordingly with summaries created in electronic file for presentation to Client's Enterprise Credentialing Committee.
- Must have technical ability to monitor individual workload assigned in credentialing system and log issues for Supervisor review.
- Analyze files to ensure compliance with recredentialing timelines and collaborate with Sr. Analysts to ensure alignment with the national CAQH Verified initiatives.
- Analyze and be familiar with CMS/State Survey/Accreditation documents for Organizational Providers and request Client Quality Management onsite electronically via Portico System.
- Perform board certification and eligibility analysis and compare to rural health practitioner Excel spreadsheet to determine certification exception eligibility.
- Resolve inquiries in Client’s electronic MACESS system related to credentialing file disposition and electronically route them to other departments appropriately.
Requirements
- Associates degree required.
- Two (2) to five (5) years’ work experience in provider enrollment, contracting and/or credentialing related field required.
- Knowledge of related state/federal regulations and NCQA, DIFS and CMS standards for credentialing required.
Preferred:
- Certified Provider Credentialing Specialist (CPCS).
- Registered Health Information Technician (RHIT).
As an equal opportunity employer, ICONMA prides itself on creating an employment environment that supports and encourages the abilities of all persons regardless of race, color, gender, age, sexual orientation, citizenship, or disability.
