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This position is responsible for ensuring professional providers applying for initial or ongoing network participation are credentialed or recredentialed in a timely and appropriate manner for presentation to the medical director and/or credentialing committee; ensure documentation for those providers approved for network participation is current at time of the committee determination.
Job Responsibility:
Ensuring professional providers applying for initial or ongoing network participation are credentialed or recredentialed in a timely and appropriate manner for presentation to the medical director and/or credentialing committee
Ensure documentation for those providers approved for network participation is current at time of the committee determination
Requirements:
High school diploma or GED
3 years business experience
1 year Credentialing OR Quality audit experience
Clear and concise interpersonal, verbal and written communication skills
Experience with multi-tasking and adhering to tight timelines
PC experience in Windows, Word, Excel, Access, and other business related/associated databases
Demonstrated analytical and organizational skills
Knowledge of Managed Care products, programs, and services
Nice to have:
2 years of college courses in Business or Medical field
Project Management experience
Previous experience in oversight of credentialing/claims activities