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Columbia

    Spec, Provider Credentialing - Columbia, United States - Ageatia Global Solutions

    Ageatia Global Solutions
    Ageatia Global Solutions Columbia, United States

    2 weeks ago

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    Description
    Job Description:

    PURPOSE:

    This role will credential practitioners for network participation with Client Client Client and accurately maintain all provider data within the enterprise-wide Provider file to supply the organization with provider data, while ensuring compliance with regulatory, accreditation, legal and company requirements and standards.

    Qualifications

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
    ccommodations may be made to enable individuals with disabilities to perform the essential functions.

    Education Level: High School Diploma

    Experience: 3 years physician credentialing experience or health insurance/managed care operations experience in a customer service, claims, billing and enrollment, or call center environment

    Preferred Qualifications
    • Bachelor's Degree in Business, Healthcare Administration or related field
    • Knowledge, Skills and Abilities (KSAs)
    • Must be proficient in the use of Excel spreadsheets, and an understanding of Pivot tables., Proficient
    • Excellent verbal and written communication and interpersonal skills. Ability to develop and maintain effective relationships with peers, physicians, and medical staff to create confidence, respect and dependability., Proficient
    • Knowledge of medical terminology, Proficient
    • Demonstrated proficiency utilizing reference materials and ability to follow Standard Operating procedures to reduce risk and ensure provider data accuracy and overall quality., Proficient
    • bility to understand jurisdictional requirements and the legal ramifications of the credentialing and provider file maintenance processes and interpret reasoning for performing verification and/or appropriate actions., Proficient
    • The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
    • Certified Provider Credentialing Specialist (CPCS) Pref
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