QualDerm Partners
Hospital & Health Care
CredentialingSpecialist
“Credentialing Specialist at QualDerm Partners. Skills: Credentialing, Payer Enrollment, Process Management. Oversee all aspects of Provider Credentialing and Payer Enrollment. Assure compliance with all health plan requirements”
What You'll Achieve.
Ensure proactive communication on credentialing and recredentialing requirements; Ensure that credentialing is complete in advance of services being rendered
Industry & Context.
Demonstrated skills in analysis, problem solving and resolution
What They're Looking For.
Must Have
Minimum of three (3) years’ experience in managed care credentialing or medical staff service setting required, Demonstrated skills in analysis, problem solving and resolution, Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information, knowledge of NCQA, Joint Commission, URAC, CMS and State Laws and regulations as they pertain to the credentialing of QualDerm providers, Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements, Must be able to function independently in a matrix environment
Nice to Have
Bachelor’s degree in related field preferred, National or multi-state credentialing experience preferred
What You'll Do.
Oversee all aspects of Provider Credentialing and Payer Enrollment
Assure compliance with all health plan requirements
Meet with assigned region operational leadership
Manages processes that maintain up-to-date data
Ensures timely renewal of licenses
Maintains confidentiality of provider information
Assist in managing the flow of information
Coordinate and prepare management reports
Manage continual process and quality improvement efforts
Participates in the training of new team members
How You'll Work.
Team & Collaboration
Develop relationships with regional operational leaders; Work with regional operational leaders to ensure timely on-boarding; Assist in managing the flow of information between payers, contracted PHO’s, ACO’s and other QualDerm networks
Communication Scope
Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information
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