Optimum RTS - Credentialing Specialist
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Credentialing Specialist

Location : Wellington
Job Type : Contract to Direct
Hours : Full Time
Travel : No
Relocation : No
Job Industry : Healthcare - Health Services
Job Category : Healthcare - Medical Office

Job Description :

Medical office in Wellington, FL seeks highly self-motivated Credentialing Specialist with a proven expertise!.

Duties and Responsibilities:

Performs all aspects of credentialing activities to ensure effective operations, compliance with government/state regulations, and that all providers are appropriately credentialed

Accurately and timely completes all applications providing accompanying documents for credentialing and re-credentialing of practitioners

Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.

Processes requests for privileges accurately

Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.

Monitors the initial, reappointment and the expirable process for all providers, ensuring compliance with regulatory bodies

Handles the review and analysis of provider applications and accompanying documents, ensuring applicant eligibility.

Prepares credentials file for completion and presentation to Credentialing manager

Manage credentialing activities by gathering appropriate provider data, review due diligence documents and document all credentialing in appropriate files/records

Manage assignments, work flow and establishes priorities on a daily basis

Able to assist with contract acquisition and follow-up

Escalate issues to the appropriate members of the credentialing team, and/or co-workers as necessary to problem solve matters through clear communications.

Ensure proper follow up is completed ahead of deadlines

Required Qualifications :
Highly motivated and success-driven with the ability to implement and manage cross-functional projects.

Minimum 2 years provider enrollment experience within a medical group/ hospital and/or managed care environment.

Strong organizational and excellent follow-up skills.

Ability to interact effectively with a variety of people (physicians and medical staff offices).

Provides highest level of customer service.

Strong written and verbal communication skills. Strong presentation and client interaction skills.

Works closely with providers (or clients) to obtain missing documentation.

Follow-up and Follow-through on all submitted applications.

Works independently and as a team solve complex problems.

Adapt well in a changing environment.

This position also requires a reliable and honest professional who has the ability to multi-task and develop positive working relationships with our clients and their internal team, as well as management.

You must have the ability to work Monday-Friday, between normal business hours.

You must adhere to all company standards, policies and workflow requirements including the use of our systems.

Proficient in Microsoft Office suite (i.e., Microsoft Word, Excel, Knowledge and understanding of the credentialing process

Ability to organize and prioritize work and manage multiple priorities

Verbal and written communication skills including letters and emails

Ability to research and analyze data

Ability to work independently with minimal supervision
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