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Job description
Delegated Credentialing Specialist IIThe Delegated Credentialing Specialist II is responsible for ensuring that all employed Memorial physicians and providers are credentialed with the appropriate delegated insurance plans, governmental agencies and any other participating insurance plans. The Specialist II oversees the preparation and processing of information and monitors compliance with regulatory and accrediting bodies as well as delegated rules and regulations. The Specialist II maintains accurate and up to date data within the relevant databases.ResponsibilitiesResponsible for compiling and completing physician and provider credentialing forms for appropriate payor delegations Initiates the verification and documentation processes for submitted applicationsCoordinates completion of physician and provider participating applications and credentialing filesCollaborates with insurance plan providers and representatives to obtain and complete specific payer credentialing forms and applicationsResponsible for preparing and providing information to various departments and external entities Communicates with appropriate billing staff regarding the status of a provider's enrollment with individual payersFacilitates provider-related research based on suspended claims, denial issues related to the enrollment process and other feedback opportunitiesProvides requested information to authorized agencies for audits and reviewsEnsures compliance with delegation monitoring and oversight requirements for credentialing functionsCollaborates with the various departments to conduct the timely credentialing delegation auditsPerforms the post-audit results meetings with insurance representatives and contributes to the resolution of any audit findingsAttends provider onboarding to obtain additional information/signatures from providersMaintains and updates physicians and provider information in the applicable databases Maintains credentialing database and provider billing number tracking sheetMonitors and tracks license and certification expirations and renewals and provider informationMaintains physician and provider directory information for departments and hospitalPerforms tracking and follow-up to ensure provider numbers are linked to appropriate entity and locationQualificationsEducation:Required - Associates degree in Business or healthcare related field; Experience may be accepted in lieu of degree requirementPreferred - Bachelor's Degree in Business or Healthcare related fieldCertification:Required - Certified Provider Credentialing Specialist (CPCS) from the National Association of Medical Staff ServicesExperience:2 years Directly related credentialing experienceSkills:Strong verbal and written communication skillsData entry with minimal errorsDatabase managementSeeking solutions using appropriate methodologiesJob InfoJob Identification 28930Job Category Clerical & Admin SupportJob Schedule Full timeJob Shift DayLocations Biloxi Annex 220 Popps Ferry Road
Worksite address
biloxi, MS, 39530, US
Who can apply
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