Jobs

    Credentialing Specialist - Greensboro, United States - Cone Health

    Cone Health
    Cone Health Greensboro, United States

    3 weeks ago

    Default job background
    Description


    Credentialing Specialist



    ID

    Location

    CHAPS Building

    Work Location

    US-NC-Greensboro


    Division :
    Name

    Cone Health Medical Group


    Department :
    Name

    MCPS-Physent-Enterprise Admi

    Category

    PROFESSIONAL/MNGMNT

    Position Sub-Category

    PROFESSIONAL/MNGMNT

    Position Type

    Full Time (40 hours/week)

    Employment Type

    Employee

    Exempt/NonExempt

    Exempt


    FTE
    1.00

    Workforce Status

    Hybrid I

    Work Hours

    40.00

    Provider Schedule (specific schedule)

    8am-5pm M-F

    On call Required

    No

    Sub Category

    Professional/Management



    Overview




    Talent Pool:
    Professional/Management

    This position is responsible for enrolling/credentialing the Health System?s individual providers in government (Medicare/Medicaid, etc.) and managed care plans as required by the regulations or contracts governing these plans.



    Responsibilities



    Complete credentialing and re-credentialing applications for these individuals in an accurate and timely manner

    Maintain a database of physicians and non-physician practitioners (CRNA-s, physician assistants, nurse practitioners, etc.) for whom the Health System is responsible for billing and/or managed care contracting.

    The database should contain participation status with government programs and managed care plans, effective dates of participation, re-enrollment deadlines and requirements, provider numbers and credentials

    Coordinate payor enrollment activities with internal credentialing functions performed by Medical Staff Services. Notify contracted payors of changes to provider panels

    Maintain an understanding of licensure and certification requirements in order to coordinate the enrollment process related to these activities



    Qualifications




    EDUCATION: Bachelors, Preferred


    EXPERIENCE: 3 years, Preferred
    3 years experience in Provider Credentialing preferred. CACTUS experience preferred.


    LICENSURE/CERTIFICATION/REGISTRY/LISTING: REQUIRED


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