The Credentialing Specialist is responsible for assisting with the activities of the credentialing department under the direction of the Credentialing Manager.
High school diploma is required. Pursuit of a Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is preferred. One to two years of experience processing credentialing and re-credentialing applications and/or managed care experience is preferred. Previous experience in an office setting is required. Basic knowledge of MHP’s mission and operational structure. Basic knowledge of the credentialing process. Basic understanding of NCQA, URAC or general accreditation credentialing requirements.
- Review application data for accuracy and completeness and input into the MCS system
- Monitor application documentation for fraud, waste and abuse and report any questionable items to the Credentialing Manager
- Create form letters, requests, inquiries and other correspondence under the direction of the manager and arrange appropriate, HIPAA approved delivery
- Maintain filing system and documentation tracking system for all credentialing information
- Schedule necessary site-visits and maintain accurate tracking of all audit events per facility
- Assist in site-visits and audits progressing to performing independent site-visits to meet department needs
- Support the Credentialing Manager in preparing for Credentialing Committee meetings and assist in the maintenance of the meeting minutes and documentation books
- Acquire and maintain knowledge of the credentialing requirements of all national and State agencies, including National Committee for Quality Assurance (NCQA), URAC, or general accreditation and support the Credentialing Manager in fulfilling credentialing department expectations
- Maintain strict confidentiality of employee and organizational information in accordance with HIPAA and State privacy regulations
- Perform other duties as assigned
Meridian Health Plan - 9 months ago
OmniCare Health Plan strives to care for everyone, or at least everyone in the southeast Michigan area. The company provides health...