Work Environment:

Hours: 8:30-5:00 pm Monday - Friday (Some optional overtime)

Contract to Perm

Onsite for a minimum of 3-6 months. Will need to be proficient in role before remote work is possible.

Description:

Responsible for the completion of the initial credentialing and re-credentialing process of providers to the network for various lines of business across the company. Maintains credentialing database and ensures provider databases are current and accurate. Provides assistance to network staff, providers, contract services, marketing, and medical affairs. Ensures compliance with external review organization standards and delegation agreements.

Responsibilities:

Responds to more complex external and internal inquiries regarding provider participation eligibility and criteria, provider data detail / structure, participation status, credentialing, contractual status, and provider file updates.

Direct focus on the provider experience, providing timely resolution dependable follow-up and proactive measures to ensure successful credentialing is achieved.

Analyzes more complex credentialing applications to perform the primary source verification of the appropriate credentials.

Once verified, accepted, and approved, determines the appropriate networks for participation and obtains the appropriate executed contracts to effectuate the professional relationship and structures the provider group accordingly.

Maintains the provider file, the provider information inventory workflow system and electronic provider files with updated provider information during processes, such as credentialing,

recredentialing, demographic updates, terminations, and all other provider file maintenance activities.

Responsible for identifying, analyzing, and resolving immediate and existing provider file issues through telephone calls, email, and system routes from operational areas.

The team basically works together:

To ensure the credentialing applications and the change requests are processed in a timely manner.

To ensure the providers are responded back to and inquiries are reached to complete service requests.

To assist teammates when necessary to ensure efficiency and timeliness of responses are being met.

Skills:

Customer service, typing, service, customer service oriented, Credentialing, Medical, Insurance verification, Prior authorization, Medical terminology, Insurance coverage, Medical billing, Data entry, Health care, Insurance, email, computer skills, Microsoft office

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.