Non-Clinical Health and Information Management Credentialing Specialist

Evansville, IN - USA

Monthly Salary: Not Disclosed

Posted on: 3 hours ago

Vacancies: 1 Vacancy

Job Summary

MISC DETAILS: *Covering a LOA - if a role is available at the end of the assignment it could be a temp to perm but not a guarantee. *The working location address is 1449 Kimber Ln Ste 103A Evansville IN 47715. *Interviews will take place via teams. *No parking fees. *This is an onsite role. *Dress code is business casual back office role. *This role could extend depending on how long coverage is needed beyond the 13-weeks. MANAGER OVERVIEW OF POSITION: The organization uses a homegrown system that does not include credentialing functionality so they rely on CAQH as their web-based credentialing data platform and the NPDB to verify documentation including criminal or sanction history. The role is responsible for credentialing 12 16 new providers per month with weekly volume varying and also managing re-credentialing for existing providers every three years. Responsibilities include maintaining accurate provider data pulling reports conducting outreach to obtain required documentation preparing paperwork for the president s signature once credentialing is complete setting providers up in the internal system and pulling data for monthly sanction meetings. The organization also works with an external company to lease networks nationwide primarily across Ohio Kentucky West Virginia and Indiana. The network of providers they credential are from out of state in the network. JOB SUMMARY: This position will coordinate the applications for initial credentialing and re-credentialing of network Dentist in accordance with our standards of and regulatory requirements. The Credentialing Specialist will also handle all applicable updates concerning network and manage all provider directories. JOB DUTIES: *Gathers verifies tracks and maintains an audit trail of all elements outlined in the Plan s credentialing and re-credentialing policies and procedures including liaison activities with primary sources for new and established dentists. *Provides administrative support for credentialing and re-credentialing including preparing accurate correspondence and reports related to provider applications. *Maintains working knowledge of credentialing and re-credentialing standards and communicates with the Dental Review Team as needed for application review. *Manages provider contracts and fee schedules. *Ensures dentist files are current with licensure DEA certificates malpractice insurance coverage malpractice claims history and National Practitioner Data Bank requirements. *Runs quarterly provider adequacy and accessibility reports. *Maintains Commercial and Medicare provider directories. *Uploads updated provider directories to Medicare and health plans monthly. *Completes network verification to meet state requirements. *Processes provider updates in the system and notifies providers upon completion. *Supports accounting with TIN verification as needed. *Processes member letters related to provider terminations. *Serves as a direct contact for provider offices requesting verification or additional information. *Acts as the primary contact for leased networks with GEHA including requesting reports and provider data. JOB QUALIFICATIONS: *Must have at least 3 years of provider credentialing experience. *Must be tech savvy with credentialing software and Excel. *Must have HS Diploma or GED. *Must have prior insurance industry knowledge and feel comfortable with terminology.