Credentialing Specialist II

Company: Federal Services
Location: Arlington
Posted on: January 15, 2021

Job Description:

Job DescriptionPosition Purpose: * The Credentialing Specialist II implements and monitors procedures, activities and/or projects related to credentialing, re-credentialing and privileging of network providers. * Processes provider applications and re-applications including initial mailing, review and loading. * Maintains provider profiling system and communication with providers by phone and mail regarding credentialing status and information. * Provides guidance to less experienced specialists. May provide workflow direction for other specialists in the department. * Analyzes all information sent in by the physician/provider and received through Federal and State queries, and compares it to established criteria. * Processes second practice applications and specialty change forms. This includes researching discrepancies and performing primary source verifications, as necessary. * Assists the Credentials Manager in tracking and reporting on credentials files for both initial credentialing and re-credentialing. * Oversees the primary source verifications and performs quality audits. * Researches all discrepancies between the information provided by the physician/provider and information received from Federal and State queries. * Determines which applicants meet criteria and which applicants will need further review. * Resolves problems and questions regarding confidential issues discovered during the credentials/re-credentials process. * Assists the Manager in determining which physician/providers are due for their biennial re-credentialing. * Interfaces with all internal departments regarding physicians/providers who are in the credentials process. * Monitors integrity of the credentials tracking databases . * Acts as a resource to the Credentials Specialists for daily questions regarding criteria, quality standards, and work processes. * Researches issues regarding physician training and query discrepancies with the appropriate program directors, medical boards and physicians as appropriate. * Reviews and prepares files requiring Medical Director Review. Education/Experience: High School diploma required. Two years prior work experience in the credentialing of health care professionals is required This position will be supporting a Federal government contract, therefore it requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Federal Services, Arlington , Credentialing Specialist II, Other , Arlington, Virginia