Job Type : Full Time
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Location : Philadelphia Pennsylvania
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Pay : Competitive Pay & Benefits!
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Job Description
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What you will be doing:
- Lead coordinate and monitor the review and analysis of practitioner applications and accompanying documents ensuring applicant eligibility.
- Conduct thorough background investigations research and primary source verification of all components of the application file.
- Identify issues that require additional investigation and evaluation validate discrepancies and ensure appropriate follow-up.
- Prepare credentials file for completion and presentation to Health System Entity Medical Staff Committees ensuring file completion within specified time periods.
- Successfully complete and maintain initial and subsequent individual provider payor enrollments i.e. Medicaid Medicare Commercial payors CHIP and other third-party insurance carriers.
- Process requests for privileges ensuring compliance with criteria outlined in clinical privilege descriptions.
- Maintain physical and electronic database of provider certifications documents expiration dates and payor enrollment information.
- Respond to inquiries from other healthcare organizations and interface with internal and external customers on day-to-day credentialing and privileging issues.
- Assist with managed care delegated credentialing audits and conduct internal file audits.
- Monitor the initial reappointment and expirable process for all SHS Professional staff Other Health Professional staff and delegated providers ensuring compliance with regulatory bodies and organizational policies.
- Perform miscellaneous job-related duties as assigned.
- Maintain a proactive working knowledge of all clinical service lines relative to the credentialing process.
- Establish goals and develop training processes to ensure maximization of technical support available.
- Analyze credentialing reporting using the Med-Trainer platform and internally maintained spreadsheets.
- Collaborate with the Revenue Cycle Director and Revenue Cycle Manager to maintain all payor rosters.
- Work in partnership with the Human Resources Department to optimize provider documentation collection.
- Establish quality review processes to ensure the effectiveness of the credentialing process and make modifications as needed.
- Ensure areas of responsibility achieve quarterly and annual goals and other established KPIs.
- Comply with federal and state laws and SHS policies and procedures related to revenue cycle management.
Experience you will need:
- High school diploma or GED; at least 6 years of experience with 4 years directly related to health center medical staff or managed care credentialing.
- Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year-for-year basis.
- Ability to communicate effectively both orally and in writing.
- Non-profit experience preferred; Federally Qualified Health Center work experience is a plus.
- Knowledge of related accreditation and certification requirements.
- Knowledge of medical credentialing and privileging procedures and standards.
- Ability to analyze interpret and draw inferences from research findings and prepare reports.
- Working knowledge of clinical and/or hospital operations and procedures.
- Ability to use independent judgment to manage and impart confidential information.
- Database management skills including querying reporting and document generation.
- Ability to make administrative/procedural decisions and judgments.
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Our client asked me to submit 3 great people within the next few days. We work directly with the hiring manager and can arrange interviews within a few days
|
#INDEH123
Job Type : Full TimeLocation : Philadelphia PennsylvaniaPay : Competitive Pay & Benefits!Job DescriptionWhat you will be doing:Lead coordinate and monitor the review and analysis of practitioner applications and accompanying documents ensuring applicant eligibility.Conduct thorough background invest...
Job Type : Full Time
|
Location : Philadelphia Pennsylvania
|
Pay : Competitive Pay & Benefits!
|
Job Description
|
What you will be doing:
- Lead coordinate and monitor the review and analysis of practitioner applications and accompanying documents ensuring applicant eligibility.
- Conduct thorough background investigations research and primary source verification of all components of the application file.
- Identify issues that require additional investigation and evaluation validate discrepancies and ensure appropriate follow-up.
- Prepare credentials file for completion and presentation to Health System Entity Medical Staff Committees ensuring file completion within specified time periods.
- Successfully complete and maintain initial and subsequent individual provider payor enrollments i.e. Medicaid Medicare Commercial payors CHIP and other third-party insurance carriers.
- Process requests for privileges ensuring compliance with criteria outlined in clinical privilege descriptions.
- Maintain physical and electronic database of provider certifications documents expiration dates and payor enrollment information.
- Respond to inquiries from other healthcare organizations and interface with internal and external customers on day-to-day credentialing and privileging issues.
- Assist with managed care delegated credentialing audits and conduct internal file audits.
- Monitor the initial reappointment and expirable process for all SHS Professional staff Other Health Professional staff and delegated providers ensuring compliance with regulatory bodies and organizational policies.
- Perform miscellaneous job-related duties as assigned.
- Maintain a proactive working knowledge of all clinical service lines relative to the credentialing process.
- Establish goals and develop training processes to ensure maximization of technical support available.
- Analyze credentialing reporting using the Med-Trainer platform and internally maintained spreadsheets.
- Collaborate with the Revenue Cycle Director and Revenue Cycle Manager to maintain all payor rosters.
- Work in partnership with the Human Resources Department to optimize provider documentation collection.
- Establish quality review processes to ensure the effectiveness of the credentialing process and make modifications as needed.
- Ensure areas of responsibility achieve quarterly and annual goals and other established KPIs.
- Comply with federal and state laws and SHS policies and procedures related to revenue cycle management.
Experience you will need:
- High school diploma or GED; at least 6 years of experience with 4 years directly related to health center medical staff or managed care credentialing.
- Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year-for-year basis.
- Ability to communicate effectively both orally and in writing.
- Non-profit experience preferred; Federally Qualified Health Center work experience is a plus.
- Knowledge of related accreditation and certification requirements.
- Knowledge of medical credentialing and privileging procedures and standards.
- Ability to analyze interpret and draw inferences from research findings and prepare reports.
- Working knowledge of clinical and/or hospital operations and procedures.
- Ability to use independent judgment to manage and impart confidential information.
- Database management skills including querying reporting and document generation.
- Ability to make administrative/procedural decisions and judgments.
|
Our client asked me to submit 3 great people within the next few days. We work directly with the hiring manager and can arrange interviews within a few days
|
#INDEH123
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Job Location:
Yearly Salary:
$ 90000 - 100000
Posted on:
2 days ago
Vacancies:
1 Vacancy
