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1
credentialing specialist
- Display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicating issues, trends and concerns to Senior Credentialing Specialist and Credentialing Manager
- Assisting with supporting credentialing program which includes ensuring the quality of credentialing of contracted providers in accordance with NCQA and URAQ guidelines
- Handle multiple states for initial and re-credentialing applications
- Manage files to continuously meet department goals while meeting daily production
- Assist with different projects (Partner Health Plan; World Trade Center; Ancillary ;PPO)
2
credentialing specialist
- Filling out insurance applications
- Making multiple calls a day to insurance companies to check the status of the providers applications
- Sending biweekly updates to the providers on their application status
- Used excel daily for documentation
3
credentialing specialist
- Submitting Medicaid recertification statements for different providers and departments
- Developed a credentialing database that is user-friendly and informative for reporting purposes
- Created a native desktop application that completed about 1,900 claims every 8 hours.
- Automated financial reporting using VBA.
- Provided technical support to fellow colleagues.
4
credentialing specialist
- Handle multiple states for initial and re-credentialing applications
- Retrieving documents received via RightFax
- Assisted in mailing monthly term letters to providers
- Reviews and screens initial medical staff credentialing applications for completeness, accuracy, and compliance with all guidelines, policies, and standards
- Performs external research and conducts verification of all applicant licensure, education and training, relevant past employment, and affiliations; assesses compliance with risk exposure criteria
- Meeting the turn around time for multiple states
- Performs internet, agency, and/or internal research as appropriate to assess past high risk/liability activity with respect to medical staff; analyzes and prepares finding and submits to management
5
credentialing specialist
- Provides a range of fiscal planning, administrative, and/or office managerial support to the CVO, as appropriate to the position.
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