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    Credentialing and Network Support Analyst - Washington, United States - Ageatia Global Solutions

    Ageatia Global Solutions
    Ageatia Global Solutions Washington, United States

    5 days ago

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    Description




    PURPOSE:

    The purpose of this job description is to perform all mail functions pertaining to the intake and enrollment process, perform updates in the credentialing system based on correspondence received from non-participating and participating practitioners and provide responses to internal and external customer service inquiries.

    Control workflow within the department. Pre-screen and assign credentialing applications. Acknowledge and research CAQH applications. Provide administrative support to the team and department.





    RESPONSIBILITIES:

    Under the direction of the Supervisor, this incumbent's accountabilities include, but are not limited to the following:

    1.

    30% Reviews and researches the FLEXX, PIMS, PORTICO and Credentialing Inventory System (where necessary) to determine if provider is new or currently exist in the Client network(s).

    Screens application and analyzes information retrieved from the LEGACY systems to determine the appropriate coding for the record to be added to Inquiry Analysis.

    Creates new record Portico/Credentialing Inventory System using the appropriate referral codes and assigns case to the Credentialing Networks Analyst. Prepares provider folder files for new providers, completes routing form and attach to case.

    Distributes case to assigned Credentialing Networks Analyst or, if provider already participating completes 'out' card, retrieves folder from file room, completes routing form and distributes file to Credentialing Networks Analyst.


    2.

    30% Picks up and delivers cases to/from other areas in the department, handles special requests for Management, Credentialing Coordinator, files needed for internal and external audits, works on special projects, maintain the supply of welcome packet materials, prepares and mails Welcome Packets based on provider type and jurisdiction,, acts as support and/or backup to other Credentialing Networks Support Representatives.


    3. 20% Retrieve process and respond to claim routes from NASCO, FACETS, FLEXX, FEP platform databases.

    Research Portico and applicable Legacy systems prior to adding a non par record to make certain accurate data elements are added to assist with claims processing and customer service.

    Process non par routes and correspondence within required timeframes.

    4. 10% Confirm all calls retrieved from the customer service line and/or departmental mailbox was answered in the required timeframe. Maintains all Excel and ACCESS databases. Makes certain the appropriate notification letters are prepared and mailed to the practice in a timely manner.

    5. 10% Download and distribute Credentialing Inventory System Reports daily.





    QUALIFICATION REQUIREMENTS:


    Required:

    High school graduate with a minimum of 2-4 years general office experience preferably in a medical or insurance environment.

    Analytical skills to research and analyze data; handle and file in specified time frame, a high volume of provider files.

    Must demonstrate attention to detail and be able to work independently while handling large volume of work accurately. Must be able to prioritize work and demonstrate flexibility.

    The Incumbent will be required as an essential part of this position to bend, stoop and file large volume of files.

    Incumbent is required to make frequent trips throughout the department, collecting and distributing files. Excellent attendance is required.


    bilities/Skills:

    ttentive to detail.
    Good written and verbal communication skills
    Excellent interpersonal skills,
    ccurate data entry skills
    bility to work at fast pace handling high volume of work,
    bility to quickly learn and retain information, prioritize multiple tasks while remaining focused,
    bility to accomplish tasks within established time frames.
    Provider file and credentialing knowledge a must.
    bility to work as a team member and independently
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