Credentialing Specialist
Centralcare, Incorporated - Annandale, VA

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Join CentralCare, Incorporated, the respected healthcare industry leader that provides highly qualified physicians, nurses, dentist and ancillary personnel to Federal Government clients. We are located in the Northern Virginia area and have been in business for more than 12 years.

CentralCare, Incorporated is continuing to grow! Currently we have an opening for a Credentialing Specialist.

This position serves as the individual responsible for overseeing the Company’s Credentialing functions.

The Credentialing Specialist will support and implement enterprise-wide Credentialing Policies and Initiatives and Organizational Development activities and will work independently.

The Credentialing Specialist will act as liaison, partnering with corporate organizations to provide assistance in the areas of Credentialing and Quality Assurance.

RESPONSIBILITIES INCLUDE:
Administers Credentialing process via network.

Works independently to coordinate, develop, monitor and maintain the credentialing process.

Reviews and processes provider applications. Determines eligibility by applying NCQA, JCAHO and URAC standards as they relate to the various DoD medial treatment facilities and submits completed file to supervisor for approval and submission.

Analyzes and resolves provider file issues, tracks progress on submissions and produces reports.

Responds to provider inquiries received by letter, phone, or internal departments.

Administers Re-credentialing of Healthcare Providers.

Reviews and monitors provider complaint and grievance files.

Performs other incidental and related duties as required and assigned.

Ensure integrity and accuracy of Credentials Tracking systems. This process requires periodic data entry, extraction, and audit of information in the database; support implementation of new system functionality and applications. Processes required documentation to ensure accurate record keeping and proper deductions.

Establish partnerships and maintain close relationships with corporate management to recognize, identify, and understand business and CCI market trends, issues, goals and needs for present and future business
initiatives.

Assist in developing, reinforcing, and fostering sound employee relation practices.

Actively develop and administer ongoing communications programs in relation to fostering effective, sound communications in all directions.

Ensure response to customer/employee inquiries and questions are being followed-up on in a timely and professional manner

Use appropriate resources to solve problems. Understand and practice safety procedures and precautions.

Maintain a high level of professionalism and confidentiality. The individual is consistently at work and on time, follows instructions, responds to management direction and solicits feedback to improve performance.

Work Conditions

Overtime may be required to meet project deadlines

Sitting for extended periods of time

Dexterity of hands and fingers to operate a computer keyboard, mouse, and other devices and objects

Physically able to participate in training sessions, presentations, and meetings

Tracy D. Turner
Director, Healthcare Staffing
CentralCare, Incorporated
7010 Little River Turnpike, Suite 335
Annandale, VA 22003
(O): 703-813-8156 Ext: 270

(C): 703-286-9964
(F): 866-404-2394
Website: http://www.centralcareinc.com
Email: tturner@centralcareinc.com

NO COLD CALLS.

Central Care, Inc. (CCI) is committed to fulfilling its role as an Equal Opportunity Employer (EEO). CCI does not discriminate against any employee or applicant for employment because of race, color, sex, religion, age, sexual orientation, gender identity and expression, national origin, marital status, physical or mental disability, status as a Disabled Veteran, Special Disabled Veteran, Armed Forces Service Medal Veteran, Recently Separated Veteran, Vietnam Era Veteran or Other Protected Veteran, or any other characteristic protected by law.

Required Skills

Required Experience

Minimum Qualifications/Education and or Experience:
4 years of experience in credentialing field

2 years of college or experience may be substituted

Experience with database reporting and proficiency with word processing and spreadsheet software.

Analytic experience

Effective verbal and written communication skills to communicate with providers via phone and prepare correspondence.

Centralcare, Incorporated - 14 months ago - save job - block
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