Associates or Bachelors in Business, Finance, Health Care or related field or high school diploma and relevant combination of education and experience
Required Skills and Abilities
Up to three years credentialing experience in a health care setting to include up to two years of practitioner enrollment, credentialing or network services experience
Experience with MD-Staff or similar practitioner credentialing, data collection and record management system
Exceptional critical thinking skills, sound judgment and the ability to communicate in an articulate and sensitive manner with practitioners, administrators, legal counsel and client credentialing personnel
Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external clients
Certified Practitioner Credentialing Specialist (CPCS)
Experience with NCQA, URAC and/or The Joint Commission guidelines and standards related to credentialing
Experience with MS Office
Matrix Medical Network is Proud to be an Equal Opportunity Employer
Credentialing Specialist is based in our Scottsdale: 9201 E Mountain View Road, Suite 220 Scottsdale, AZ 85258. Matrix Medical Network partners with leading health plans and providers across the country. Primary Location: Scottsdale-Arizona Work Locations: 9201 E Mountain View Road, Suite 220 Scottsdale, AZ 85258 Job: Credentialing Specialist Schedule: Regular Shift: Standard Employee Status: Individual Contributor Job Type: Full-time Job Level: Day Job Travel: Primary Location-United States 9201 E Mountain View Road, Suite 220 Scottsdale, AZ 85258 Hours: Monday - Friday 8AM - 5PM. No on-call, evening or weekend hours. Credentialing Specialist , Schedule, Full-Time, Regular, Job Type, Standard, Pay, Hours
- Perform the initial credentialing and recredentialing functions for employed and contracted Matrix providers, which may include collaborating physicians and Locum Tenens.
- Review provider applications for completeness and accuracy.
- Ensure appropriate follow-up within established timeframes, monitor and report on the credentialing progress of each provider.
- Maintain timely and accurate data entry and periodically revise provider data in the Matrix credentialing database.
- Accurately maintain provider files for Matrix providers.
- Ensure timely and accurate credentialing and recredentialing application submissions for each provider as it relates to each client health plan; monitor and report progress of each practitioner.
- Enroll providers with Medicaid and Medicare and all applicable client health plans; monitor and report on progress of each provider.
- Ensure all providers who require collaboration agreements are appropriately assigned to a collaborating physician and the agreement is executed by both parties; monitor and report progress of each provider.
- Ensure employed providers are enrolled under the Matrix professional liability insurance plan; monitor and report progress on each practitioner.
- Respond to all provider, client health plan and internal inquiries in a timely manner within one (1) business day.
- Conduct sanctions and compliance monitoring and alert credentialing leadership of any undisclosed negative findings immediately.
- Assist traveling providers with obtaining new state licenses in areas identified by the clinical management team; monitor and report progress of each provider.
- Adhere to Matrix policies and procedures including timely delivery of completed work and use of resources.
- Identify, analyze and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll providers and ultimately bill and obtain reimbursement for services rendered; discover and convey problems to credentialing leadership so that the optimal course of action is taken by making sound decisions in accordance with department and corporate guidelines.
- Utilize extensive internet and telephone communication to obtain critical pertinent information.
- Keep credentialing leadership informed of potential credentialing or enrollment issues.
- Ensure strict confidentiality at all times.
- Other duties as assigned.
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