Job description

• Correct payments or denials if necessary and appropriate, in accordance with claim adjudication guidelines
• Diffuse irate callers by attentive listening, maintaining a professional tone, and acknowledging their concerns by paraphrasing
• Exercise good judgment, interpret medical claim data and contracts, and remain knowledgeable in related company policies and procedures
• Maintain teamwork, customer service production and quality standards to assure timely, efficient and accurate call resolution
• Maintaining compliance with regulatory and accrediting bodies
• Participating in the development and implementation of credentialing processes and procedures
• Credentialing of physicians and allied health professionals
• Collecting and maintaining an accurate practitioner database and analyzing verifications
• Credentialing physicians and allied health professionals
• Collecting and maintaining an accurate practitioner database

Qualifications for credentialing specialist

• Analyzing verifications
• SQL experience
• Establishing and maintaining a system for timely processing of credentialing and re-credentialing files in accordance with the company, CMS and NCQA policies
• Ensuring that providers/HDOs on the company's participating panel are in compliance with the company policies and NCQA and state and federal regulatory standards
• Maintaining current knowledge of NCQA, State and Federal requirements
• Performing data entry in and maintaining currency of the database for tracking practitioner / HDO credentialing and re-credentialing information
• Initiating and conducting primary source verification of provider credentials

Job Type: Full-time

Pay: $18.00 - $19.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• Overtime

Supplemental pay types:

• Bonus pay

Ability to commute/relocate:

• Palm Springs, FL 33406: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Microsoft Office: 3 years (Required)
• SQL: 3 years (Required)

Work Location: One location

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