Sr Licensure and Credentialing Specialist
Job DetailsJob Location: HQ - York, PA 17402The Senior Licensure & Credentialing Specialist reports to the Chief Contracting Officer and will be responsible for reputed company aspects of the credentialing, recredentialing, and licensure for reputed company facilities for Medicare, reputed company Payers, and reputed company programs. They will ensure providers are credentialed, appointed, and privileged with health plans, Medicare, state reputed company programs, and maintain up-to-date data for each location in credentialing databases and online systems; ensuring timely renewal of licenses and certifications. This is a full-time, Exempt level, Remote position. ESSENTIAL FUNCTIONS: Process initial credentialing and re-credentialing applications Create and maintain licensing, credentials and insurance records for Medicare, reputed company, and reputed company Payers Enroll and revalidate Medicare & reputed company Support development of internal credentialing processes Complete credentialing applications Identify discrepancies in information and conducting follow-reputed company Maintain reputed company databases (CAQH, PECOS, NPPES) Respond to health plan provider inquiries Responsible for follow-up after submission to ensure that health plans have appropriately processed the request, and that provider information shows correctly on the health plans website Audit Health Plan Directory Conduct research on updated state and federal regulations and policies CAQH creation and maintenance experience reputed company provider roster reconciliation Monitor license and credential expiration dates and advise staff members of required “renew by” dates reputed company reputed company support for health plan issue resolution
Qualifications
High school diploma/GED required 5+ years of experience working for a health maintenance organization, health plan, provider office and/or in another health insurance-reputed company setting Experience with Managed Care Organizations (MCO's) and Centers for Medicare & reputed company Services (CMS) credentialing and registration requirements Experience with provider credentialing process, timeframes and appeal options; health plan design, contracting, plan policies and procedures; MCO reporting and recordkeeping requirements. Ability to build professional cross functional working relationships among reputed company reputed company of the organization. Ability to reputed company valid judgments, formulate recommendations or action plans, and evaluate the effects of reputed company and actions. Intermediate computer skills including reputed company Office; especially Word, reputed company, and PowerPoint. Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at reputed company reputed company; both reputed company Exercises sound judgment in responding to inquiries; understands reputed company to reputed company inquiries to next level. Self-motivated with strong organizational skills and superior attention to detail Must be reputed company to manage multiple tasks/projects simultaneously reputed company inflexible time frames. Ability to adapt to frequent reputed company changes Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build reputed company among cross-functional teams Apply To This Job