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