Credentialing Specialist

ASM Research, An Accenture Federal Services Company • Madison, WI • 2h ago

Processes credentialing and re-credentialing applications for the client. Reviews applications and prepares verification letters. Contacts various departments, licensing agencies, and insurance carriers to complete credentialing and re-credentialing applications. Provides support to the client in the collection and query of credentials of members of the client.

Conducts Primary Source Verification (PSV) of credentials such as licenses, certifications, registrations, professional school education, postgraduate, residency, or specialty training, board certifications, work history, and current references.

Conducts queries through the National Practitioner Data Bank (NPDB), the Defense Practitioner Data Bank (DPDB), the Department of Health and Human Services (DHHS) and TRICARE sanction data banks.

Collects professional/peer references and completed clinical privileges, demographics, military and civilian practice history (including adverse privileging actions and malpractice history), health status, documentation of contingency and continuing education training, national provider identification number, and for non-personal services contract providers malpractice insurance information.

Accurately loads appropriate data in the DoD Centralized Credentials Quality Assurance System (CCQAS). Keeps records and documentation of the applications and verifications maintained.

Establishes and maintains updated CCQAS records.

Researches and solves credentialing/re-credentialing problems; escalates more complex issues as appropriate.

Tracks status of credentials for healthcare practitioners and provides required documents to clients to make accession, credentialing and privileging (C&P) decisions.

Maintains relationships with Military Treatment Facilities and supported customers.

Ensures providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities.

Reviews records for regulatory compliance and quality assurance at a healthcare facility, insurance group, or similar organization, ensuring relevant regulations are met.

Minimum Qualifications

HS diploma or GED; Bachelor's Degree in healthcare or business field preferred

Certified Provider Credentialing Specialist (CPCS) preferred

2-5 years of experience performing physician credentialing at a medical group, hospital or health plan.

Other Job Specific Skills

Strong customer focus, interpersonal, collaboration, written/verbal communication, prioritization and computer skills.

Strong attention to detail and good organizational capability.

Able to handle multiple simultaneous tasks and complete work projects in designed time frames.

Knowledge of Department of Defense credentialing guidelines preferred.

Experience using Centralized Credentials Quality Assurance System (CCQAS) and Defense Medical Human Resources System - internet (DMHRSi) a plus.

Ability to handle confidential information on a daily basis in a professional manner.

Ability to consistently maintain quality and production expectations.

Possess proof-reading skills sufficient for auditing documents.

Demonstrate familiarity with credentialing policies, guidelines, and regulations for the DoD credentialing process.

Compensation Ranges

Compensation ranges for ASM Research positions vary depending on multiple factors; including but not limited to, location, skill set, level of education, certifications, client requirements, contract-specific affordability, government clearance and investigation level, and years of experience. The compensation displayed for this role is a general guideline based on these factors and is unique to each role. Monetary compensation is one component of ASM's overall compensation and benefits package for employees.

EEO Requirements

It is the policy of ASM that an individual's race, color, religion, sex, disability, age, sexual orientation or national origin are not and will not be considered in any personnel or management decisions. We affirm our commitment to these fundamental policies.

All recruiting, hiring, training, and promoting for all job classifications is done without regard to race, color, religion, sex, disability, or age. All decisions on employment are made to abide by the principle of equal employment.

Physical Requirements

The physical requirements described in "Knowledge, Skills and Abilities" above are representative of those which must be met by an employee to successfully perform the primary functions of this job. (For example, "light office duties' or "lifting up to 50 pounds" or "some travel" required.) Reasonable accommodations may be made to enable individuals with qualifying disabilities, who are otherwise qualified, to perform the primary functions.

Disclaimer

The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

24.00-26.00

EEO Requirements

It is the policy of ASM that an individual's race, color, religion, sex, disability, age, gender identity, veteran status, sexual orientation or national origin are not and will not be considered in any personnel or management decisions. We affirm our commitment to these fundamental policies.

All recruiting, hiring, training, and promoting for all job classifications is done without regard to race, color, religion, sex, veteran status, disability, gender identity, or age. All decisions on employment are made to abide by the principle of equal employment.

Similar Jobs

Advanced Specialist, Content Producer

Pearson • Madison, WI • 2h ago

Advanced Specialist, Content Producer Position Summary The Advanced Specialist, Content Producer provides leadership and oversight for the end-to-end development of Certiport certifications and related assessment product...

2h ago

Go to Apply

Financial Advisor Private Wealth

FIRST BUSINESS BANK • Madison, WI • 3h ago

Finance, Accounting & Banking

JOB REQUIREMENTS: Description Position at First Business Bank Financial Advisor | Private Wealth Launch Your Wealth Management Career with an Established Client Base Work Model: This role is onsite at our Madison, WI OR...

3h ago

Go to Apply

Treasury Management Business Development

ONE COMMUNITY BANK • Cottage Grove, WI • 3h ago

Finance, Accounting & Banking

JOB REQUIREMENTS: Why One Community Bank Why join One Community Bank? Our actions demonstrate our tenets: Invest in Relationships, Trust the Team, See the Upside, Encourage New Ideas and Think Big! We serve clients, supp...

3h ago

Go to Apply

Financial Advisor Private Wealth

FIRST BUSINESS BANK • Madison, WI • 3h ago

Finance, Accounting & Banking

3h ago

Go to Apply

Engagement Owner - State and Public Health

Oracle • Madison, WI • 4h ago

Hospital & Medical

Job Description This position is needed to fulfill a role responsible for working across all state and federal markets with Medicaid, Medicare, and other state-based directives, to also include the Centers for Medicare a...

4h ago

Go to Apply

Senior Project Manager - Construction

Kraus-Anderson • Madison, WI • 4h ago

Trucking & Construction

Kraus-Anderson offers an opportunity to make an immediate impact with an industry leader! Core Purpose: Building enduring relationships and strong communities Core Values: Integrity - Do the right thing...always be respe...

4h ago

Go to Apply

Registered Nurse

SSM Health • Madison, WI • 7h ago

Hospital & Medical

It's more than a career, it's a calling. WI-SSM Health Dean Medical Group Madison North High Point Worker Type: PRN Job Summary: Provides direct nursing care in accordance with established policies, procedures and protoc...

7h ago

Go to Apply

Lead Project Manager-Clinical Operations

Humana • Madison, WI • 8h ago

Hospital & Medical

Become a part of our caring community The Lead Project Manager serves as a strategic leader responsible for overseeing large, complex, and highly visible programs that span multiple workstreams, business areas, and stake...

8h ago

Go to Apply

Renewal Operations Manager

Zoom • Madison, WI • 8h ago

Management & Administrative

What You Can Expect This role is the operational backbone of Zoom's Renewals function, responsible for transforming how the business forecasts, interprets, and acts on renewal and churn performance across a global, multi...

8h ago

Go to Apply

Account Director

Zayo • Madison, WI • 8h ago

United States Full time R0017609 Company Description Zayo provides mission-critical bandwidth to the world's most impactful companies, fueling the innovations that are transforming our society. Zayo's 141,000-mile networ...

8h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)