Credentialing Specialist

ASM Research, An Accenture Federal Services Company • Trenton, NJ • 1h 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

Retail Sales Consultant

AT&T • Willow Grove, PA • 42min ago

Retail & Hospitality

LOCATION - WILLOW GROVE, PA (WILLOW GROVE MALL) It's time to take your sales career to the next level. Every day you'll be at the center of it all. Your goal? Create meaningful connections with every customer, with your...

42min ago

Go to Apply

College Student - Technical - Intern

Lockheed Martin • Mount Laurel, NJ • 1h ago

IT & Engineering

Standard Job Description What We're Doing As a part of the Lockheed Martin community, we take on challenges and find solutions using creativity and collaboration. If you're looking to be a part of a passionate team solvi...

1h ago

Go to Apply

CERCLA/RCRA Engineering Support II (Remedial Project Manager Support)

Cherokee Federal • Philadelphia, PA • 1h ago

Management & Administrative

JOB DESCRIPTION CERCLA/RCRA Engineering Support II (Remedial Project Manager support) San Diego, CA, United States A government contract requires that this position be restricted to U.S. citizens or legal permanent resid...

1h ago

Go to Apply

Advanced Specialist, Content Producer

Pearson • Trenton, NJ • 1h 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...

1h ago

Go to Apply

Teller

The Bank of Princeton • Dayton, NJ • 2h ago

Finance, Accounting & Banking

T he Bank of Princeton has exciting career opportunities! Our goal to hire and retain talented cooperative people with engaging personalities and strong work ethics. We believe in recognizing and rewarding employees who...

2h ago

Go to Apply

Assistant Branch Manager

The Bank of Princeton • Moorestown, NJ • 2h ago

Retail & Hospitality

The Bank of Princeton has exciting career opportunities! Our goal to hire and retain talented cooperative people with engaging personalities and strong work ethics. We believe in recognizing and rewarding employees who c...

2h ago

Go to Apply

Assistant Branch Manager

The Bank of Princeton • Cranbury, NJ • 2h ago

Retail & Hospitality

The Bank of Princeton has exciting career opportunities! Our goal to hire and retain talented cooperative people with engaging personalities and strong work ethics. We believe in recognizing and rewarding employees who c...

2h ago

Go to Apply

Business Banking Relationship Manager - Southern New Jersey

Bank of America • Jenkintown, PA • 2h ago

Finance, Accounting & Banking

Business Banking Relationship Manager - Southern New Jersey Cherry Hill, New Jersey;Jenkintown, Pennsylvania To proceed with your application, you must be at least 18 years of age. Acknowledge ( https://ghr.wd1.myworkday...

2h ago

Go to Apply

Business Banking Relationship Manager - Southern New Jersey

Bank of America • Cherry Hill, NJ • 2h ago

Finance, Accounting & Banking

2h ago

Go to Apply

Community Banking Manager III -Newtown

FIRSTRUST SAVINGS BANK • Newtown, PA • 2h ago

Finance, Accounting & Banking

FIRSTRUST BANKRecognizes the leader in you As one of the region's foremost community banking institutions, we take pride in fostering leadership. As a Firstrust employee, your growth is our growth. For you, that means gr...

2h ago

Go to Apply

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