Health First hiring HFMG Payer Credentialing Specialist 1 - Managed Care in Rockledge, FL | LinkedIn (2024)

DescriptionPOSITION SUMMARY The HFMG Payer Credentialing Specialist 1 (CS1) is responsible for maintaining all provider Council on Affordable Quality Healthcare (CAQH) credentialing profiles along with importing CAQH and other required information into Credential Stream (CS) or subsequent software for the purposes of supporting provider enrollment and delegated credentialing functions of the department. This includes the gathering of required documents and information directly from the provider or designee on behalf of employed HFMG health care providers. The CS1 position will also be responsible for working with team members and supporting them by ensuring that the systems contain all information needed for them to complete their duties.

Primary Accountabilites

• Achieve expert level knowledge of CAQH and CS.
• Maintain working knowledge of, and remain current with, each contracted payer’s credentialing and/or enrollment data requirements along with maintaining this documentation in CS.
• Gather all required enrollment data elements to complete and maintain provider’s CAQH and CS profiles without gaps.
• Using a CredStream report driven by expiration dates, at the time intervals programmed within the software, schedule a regular cadence for document renewals to maintain provider profiles. Document each follow up with notes within the software system until completion.
• Follow the path for escalation per the department policy and procedure, documenting efforts of escalation within the software when physicians and mid-levels have failed to cooperate with or meet the requirements of their employment contract, specific to providing information to support credentialing functions and expectations.
• Professionally communicate any extra documentation requirement needs to the provider or their designee that are outside CAQH, or CS to achieve payer documentation requirements.
• Organize and maintain confidential provider files within the various databases and internal electronic files using the proper naming parameters.
• Serve as an expert and information source concerning CAQH, CS, required documents, expirable documentation reports and par status of providers.

QualificationsMINIMUM QUALIFICATIONS

• Education: Associate’s degree in medical administration, health sciences, business or related field.
• Work Experience: None
• Licensure: None
• Certification: None
• Skills/Knowledge/Abilities:
• Exceptional interpersonal, communication and organizational skills.
• Excellent organizational skills with ability to coordinate multiple tasks on an ongoing basis required.
• Advanced technical skills for use of MS Office (Excel, Word, Outlook and SharePoint).
• Strong time-management skills with ability to adapt to changing organizational requirements and business applications.
• High degree of accuracy, efficiency, productivity, dependability, and confidentiality.
• Ability to work independently with minimal supervision.
• Advanced problem-solving skills.
  

Preferred Qualifications

• Education: Bachelor’s degree in medical administration, health sciences, business or related field.
• Work Experience: 2 years’ experience in CVO, medical staff office or health plan credentialing.
• Licensure: No additional
• Certification: No additional
• Skills/Knowledge/Abilities: No additional

Physical Requirements

• Majority of time involves sitting or standing; occasional walking, bending, stooping.
• Long periods of computer time or at workstation.
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined; on site or remote.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

JobQuality

OrganizationHealth First Shared Svcs Inc

Primary Location :

United States- Florida - Brevard County- Rockledge

ScheduleFull-time

Shift Times8:30 am — 5:00 pm

Job LevelAssociate