Description :

• Process , track, and file credentialing applications within established policies and procedures while maintaining and updating the credentialing database
• Provided credentialing and re-credentialing to various providers including physicians, healthcare delivery organizations, or pharmacies according to specifications.
• Tracked and followed up with Provider Primary Source Verification (PSV) and coordinated with the Credentialing Verification Organization (CVO).
• Assist with the preparation and coordination of the Credentialing Committee
• Participate in credentialing delegation audits, as requested by the Manager, with selected provider groups and subcontracted vendors
• Provide credentialing and re-credentialing to various providers including physicians, healthcare delivery organizations, or pharmacies according to specifications.
• Responded to internal and external customer inquiries regarding credentialing status
• Ensure all primary source verification is completed within the time-frame allowed
• Ensure strict compliance with regulatory bodies, including Joint Commission, NCQA, URAC, CMS, AAHC, Medicaid, and Medicare
• Maintain and update the credentialing database

Skills :

healthcare, managed care, Customer service oriented, Customer service, Health insurance, member service

Top Skills Details :

healthcare, managed care, Customer service oriented

Additional Skills & Qualifications :

• Excellent oral and written communication skills
• Excellent customer service skills
• Ability to multi-task and prioritize
• Ability to work well within a team environment and independently
• Strong knowledge and experience with Microsoft Office, Outlook, Excel, and general office products
• Ability to learn new software programs
• Require dexterity to type at least 60 WPM

EDUCATION :

High school education or GED Equivalent Required

EXPERIENCE : 2 years

Experience Level : Entry Level

Entry Level

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.

Last updated : 2024-05-14