Dane Street, LLC
Insurance
CredentialingAssistant
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Credentialing Assistant at Dane Street, LLC. Skills: Credentialing, Primary source verification, Background checks, Malpractice checks, Sanctions check clearinghouse reports. Screening reviewers for required credentialing and background information. Performing online searches of reviewers”
Industry & Context.
Long periods of sitting and computer work, Supply and support their own internet services, Maintaining an uninterrupted internet connection is a requirement of all work from home position, Apple equipment and a media stipend are provided for remote workspace
What They're Looking For.
Must Have
Computer literacy, Typing skills
Nice to Have
Associate’s Degree, Bachelor’s Degree, Credentialing experience in a healthcare or insurance setting
What You'll Do.
Screening reviewers for required credentialing and background information
Performing online searches of reviewers
Conducting primary source verification of reviewer board certifications
and malpractice checks
Uploading documents to the electronic reviewer file
Producing Judgments page to include comments from the Medical Director
Applying client Do Not Use status as required
Communicating the application status with the Operations team
Sending applications to reviewers
Referring reviewers with “red flags” to the Medical Director for review
Indicating Do Not Use status and Medical Reviewer comments in Judgments document
and registrations for expiration status
Creating and receiving sanctions check clearinghouse reports and search for each sanction identified
Finding supporting documentation
including court documents or National Practitioner Data Bank reporting
Sending information to the Medical Director for review
Obtaining W-9 documents in response to address changes
Cloning profiles in the event of a fundamental identifying data change
Removing reviewers from the panel based on client or Operations department requests
Performing data entry of new fees or updated fees
Obtaining new fee agreements as appropriate
Assisting Dane Street Team Members with Credentialing Content
Providing credentialing related advice to leadership and for contracting and Operations functions
How You'll Work.
Team & Collaboration
Coordination between multiple departments at Dane Street; Communicates the application status with the Operations team; Participation on the Quality Management Committee meetings; Requested follow up activities; Assist Dane Street Team Members with Credentialing Content; Providing credentialing related advice to leadership and for contracting and Operations functions
Communication Scope
Excellent communication skills
Full Job Description
**JOB SUMMARY** The Credentialing Assistant is responsible for screening reviewers for required credentialing and background information, including professional sanctions and criminal background information. The position requires coordination between multiple departments at Dane Street to provide support relating to the information, data, and standards involved in reviewer credentialing. Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results. **MAJOR DUTIES & RESPONSIBILITIES** * Initial Credentialing: Enters reviewer application data, performs online searches of reviewers, conducts primary source verification of reviewer board certifications, licenses, background checks, and malpractice checks. Uploads documents to the electronic reviewer file, produces Judgments page to include comments from the Medical Director. Applies client Do Not Use status as required. Communicates the application status with the Operations team, including when an application is denied by the Medical Director. * Recredentialing of Reviewers: Sends applications to reviewers, conducts prime source verification of board certifications, licenses, and malpractice checks. Performs online searches of reviewers. Refers reviewers with “red flags” to the Medical Director for review. Indicates Do Not Use status and Medical Reviewer comments in Judgments document. * Updating Expired Licenses, Board Certifications, and Workers’ Compensation Registration: Reviews licenses, certifications, and registrations for expiration status. * Exclusions, Preclusions, Background and Sanction Checks: Creates and receives sanctions check clearinghouse reports and search for each sanction identified. Finds supporting documentation, including court documents or National Practitioner Data Bank reporting. Sends information
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