CREDENTIALING SPECIALIST
Company: OnPoint Medical Group
Location: Englewood
Posted on: September 28, 2024
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Job Description:
OnPoint Medical Group is searching for an outstanding
Credentialing Specialist to join our team! Come join a great group
of medical professionals as our network continues to grow!OnPoint
Medical Group is a physician-led network of skilled Primary and
Urgent care providers who are committed to expanding access to
quality healthcare in the most effective and affordable manner
possible.Our Circle of Care has one primary goal to ensure the
health and wellness of members and their families. We do this by
providing access to a comprehensive menu of medical services from
one unified physician group in their neighborhoods. With doctors,
nurses, specialists, labs and medical records all interlinked and
coordinated, patient care has never been in better hands.OnPoint
Medical Group is looking to hire an organized, meticulous, and
self-driven Credentialing Specialist to assist us with
administrative tasks pertaining to out practitioners credentialing.
The Credentialing Specialist will organize, maintain, and verify
all aspects of the process, and maintain current files on
practitioners. You will track the expiration of certifications to
maintain up to date files, and assist health plan providers and
customer with phone inquiries.The Credentialing Specialist will
work in the corporate office in Highlands Ranch, Co. This is not a
remote position. To be successful in this role you should ensure
currency and accuracy of all information. Preferred candidates will
be reliable, energetic and have excellent people skills.
CREDENTIALING SPECIALIST RESPONSIBILITIES Processing initial
credentialing and re-credentialing applications Screening
practitioners applications and supporting documentation to
ascertain their eligibility Identifying discrepancies in
information and conducting follow-ups Maintenance of internal and
external databases (CAQH, PECOS, NPPES) Assisting customers with
credentialing inquiries Responding to health plan providers
inquiries Responsible for follow-up after submission to ensure that
health plans appropriately processed the request and that provider
information shows correctly on the health plans website Audits
Health Plan Directory CAQH creation and maintenance experience
Medicare & Medicaid enrollment and revalidation Perform provider
roster reconciliation Initial and reappointment of hospital
privileges. CREDENTIALING SPECIALIST REQUIREMENTS High school
diploma or GED required (Bachelors Degree preferred) 3+ years
credentialing experience Certified Provider Credentials Specialist
(CPCS) preferred Knowledge of Medicare & Medicaid enrollment and
revalidation Knowledge of medical credentialing and privileging
procedures and standards Excellent verbal and written communication
skills Proficient with Microsoft Office Word & Excel (Vlookup)
Demonstrate skills in problem solving analysis and resolution
Attention to detail Must be able to function independently and as a
team Demonstrate flexibility in multiple project manager and strict
deadlines CUSTOMER SERVICE EXCELLENCE Provide customer service in
accordance to practice mission Demonstrate ability to be courteous
and respectful when interacting with patients and family members
Maintain patient confidentiality in accordance to policy and
procedure and HIPAA requirements Enact proper chain of command for
patient complaintsLANGUAGE SKILLS Ability to read, analyze, and
interpret general business periodicals, professional journals,
technical procedures, or governmental regulations Ability to write
reports, business correspondence, and procedure manuals Ability to
effectively present information and respond to questions from
groups of managers, patients, and the general publicMATHEMATICAL
SKILLS Ability to add, subtract, multiply, and divide in all units
of measure, using whole numbers, common fractions, and decimals
Ability to compute rate, ratio, and percent and to draw and
interpret bar graphs. REASONING ABILITY Ability to define problems,
collect data, establish facts, and draw valid conclusions Ability
to interpret an extensive variety of technical instructions in
mathematical or diagram form and deal with several abstract and
concrete variables APTITUDES AND TEMPERAMENTS REQUIRED Must have a
high level of energy with the ability to adjust to any justifiable
pace. Make decisions based more on fact than feeling Exhibit
behavior which emphasizes compassion, quality, loyalty and
conscientiousness Ability to establish and maintain effective
working relationships with patients, their families and staff
members SUPERVISORY RESPONSIBILITIESThis position has no
supervisory responsibilities JOB ELEMENTS/WORKING CONDITIONS While
performing the duties of this job, the employee is regularly
required to stand; use hands to finger, handle, or feel; reach with
hands and arms; and talk or hear. Travel between sites and
locations Some flexibility with non-traditional work hours may be
needed to accommodate the end-user's schedules during pre and post
Go-Lives. Occasionally required to walk; sit; and stoop, kneel,
crouch, or crawl. Frequently lift and/or move up to 10 pounds and
occasionally lift and/or move more than 25 pounds. Specific vision
abilities required by this job include close vision, distance
vision, and ability to adjust focus. WORK ENVIRONMENTThe above
statements describe the general nature and level of work performed
by people assigned to this classification. They are not an
exhaustive list of all responsibilities, duties and skills required
of personnel so classified. All personnel may be required to
perform duties outside of their normal responsibilities from time
to time, as needed. BENEFITS OFFERED
Keywords: OnPoint Medical Group, Denver , CREDENTIALING SPECIALIST, Other , Englewood, Colorado
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