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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.