Credentialing Professional at The Judge Group Inc. in Atlanta, Georgia

Job Description:

Location: REMOTE

Salary: $18.00 USD Hourly - $22.00 USD Hourly

Description: A Prestigious client is currently seeking a Remote Credentialing Professional



This job will have the following responsibilities:

• Perform duties related to organizational and individual provider credentialing, caregiver background checks, and delegation oversight audits for Medicare, Medicaid, and Long-Term Care Programs through accurate performance of provider data collection, verifications, documentation review, provider data reporting, and sound judgment/decision making.


• Perform review of incoming provider applications for complete information from credentialing vendor and organizational providers.


• Ensures that providers meet requirements of credentialing process.


• Perform credentialing delegation oversight reviews of delegated provider network.


• Conduct validation reviews of provider's performance of initial and ongoing provider caregiver background check audits as needed.


• Prepare provider credentialing files and credentialing materials for Credentials Review Committee.


• Maintains accurate, up to date provider data in database and spreadsheets.


• Assist with the mailing of credentialing and creation of credentialing approval letters for communicating credentialing decisions to providers.


• Respond to provider and internal inquiries regarding credentialing status


• Document/track Credentialing Committee decisions and implement associated actions timely.


• Coordinate and complete delegated audit reviews ensuring compliance with all regulatory guidelines; document/track results, identify compliance gaps, and implement/monitor corrective action plans for compliance gaps.


• Complete caregiver background check audits; document/track results, identify compliance concerns, and implement/monitor corrective action plans for compliance gaps.


• Track, synthesize, and ensure provider credentialing data integrity while maintaining efficiency.


• Prepare and distribute accurate and timely reports according to department policies, documentation standards and regulatory requirements.


• Perform outreach to providers for updated credentials as part of ongoing monitoring.


• Assist with other credentialing and provider data projects and initiatives: Network Adequacy Review, Provider Surveys, HEDIS/5-Star, External Quality Reviews, and Performance Improvement Projects, as assigned


• Looking for a candidate that has done credentialing for organizational providers, examples: hospitals, skilled nursing facilities, home health, ambulatory centers etc.
  
  

Hours: Mon-Fri; 8:00AM - 5PM Central Standard Time

Length of Contract: 6 months





Qualifications & Requirements:

• Prior credentialing experience


• Prior work experience and knowledge of Long Term Care, Medical, Behavioral Health, and Ancillary providers


• Knowledge and experience with NCQA standards


• Knowledge of Long Term Care, Medical, Behavioral Health, and Ancillary provider background requirements


• At least 3-5 years managed health experience
  
  


• Bachelor's degree in a healthcare, social work, quality management or related field or equivalent experience.


• At least 1-3 years prior work experience with and knowledge of credentialing.


• Proficiency with PC- based systems and the ability to learn new information systems and software programs required.


• Ability to interact effectively with healthcare providers.
  
  

Contact: khawkins@judge.com


This job and many more are available through The Judge Group. Find us on the web at www.judge.com Apply Now