Credentialing Specialist
Full Time
San Antonio, TX 78240
Posted
Job description
Qualifications:
Job Duties and Responsibilities:
The duties include but are not limited to the following:
- Minimum Education/Experience: Three years of experience in medical credentialing to include one year of knowledge of the credentialing and privileging process, the required credentials for health care professionals, and the appropriate sources used to complete Prime Source Verification, work history verifications, sanction checks, and databank queries.
Job Duties and Responsibilities:
The duties include but are not limited to the following:
- Reviews credentialing applications, conducts follow-up in a timely manner to obtain missing credentials/information, conduct verifications, create provider credentialing records within CCQAS and maintain the CCQAS record. Records must always be current.
- Contacts medical office staff, educational institutions, employers, licensing and certifying agencies, to obtain and complete the verification of credentials.
- Obtains required credentials and complete PSV of the credentials from the originating source or designated agent, date stamps the documentation upon receipt.
- Updates the appropriate screens within CCQAS to capture the credential and PSV of the credential. Converts documentation to a PDF format, scans, appropriate names, and uploads the documentation to the provider’s electronic credentials file.
- Completes credentialing tasks routed to the DHACCVO for action and appropriately updates the provider’s electronic credentials file.
- Identifies and reports potential “red flags” to the requestor and submits required credentials verification summaries, completes verification tasks within CCQAS and scans, appropriately names and uploads required documentation to CCQAS.
- Audits provider credentials application and credentials file for compliance with requirements outlined in regulatory guidelines.
- Transfers provider credentials files to MTF credentials office or training office as appropriate. Closes out and inactivates electronic JCCQAS records when appropriate.
- Responds to queries/request for information and resolves originating request or routes the request to the appropriate individual for resolution.
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