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Top 50 Credentialing Specialist Skills

Below we've compiled a list of the most important skills for a Credentialing Specialist. We ranked the top skills based on the percentage of Credentialing Specialist resumes they appeared on. For example, 25.3% of Credentialing Specialist resumes contained Providers as a skill. Let's find out what skills a Credentialing Specialist actually needs in order to be successful in the workplace.

These are the most important skills for a Credentialing Specialist:

1. Providers

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high Demand
Here's how Providers is used in Credentialing Specialist jobs:
  • Work closely with providers to obtain all necessary documentation needed for locum placement at different facilities.
  • Created spreadsheets in Microsoft Excel on providers that were presented to committee for credentialing/re-credentialing.
  • Handled confidential information regarding malpractice suits against the providers.
  • Assist providers with completion of credentialing and re-credentialing applications.
  • Communicated and educated providers on the credentialing process, maintaining a positive and professional manner at all times.
  • Develop, analyze and maintain a grid of contacts, procedures and providers enrolled for each state.
  • Complete initial credentialing application and questionnaires with newly hired providers for DMG, CRS and MIHS facilities.
  • Send out all approval letters to providers that have been approved by the credentialing committee.
  • Work closely along with health plans to complete the process of credentialing providers.
  • Maintain contact with Providers to resolve issues and obtain missing or incomplete information.
  • Monitor all active providers and groups to ensure continued growth of the network.
  • Prepare applications for signatures, send, track and receive from providers.
  • Worked with Provider Services and the providers by providing responses to inquiries.
  • Review and enter providers information into the system.
  • Completed Meaningful Use Attestations Stage 1, year 1 & 2; and Stage 2 for 40+ providers.
  • Maintained CAQH, NPPES, and IACS accounts for providers.
  • Verified Boards, State Registration and Malpractice History Entered and updated providers Credentials.
  • Interacted heavily with providers and in a timely manner
  • General Description: Manages credentialing tasks for Anesthesia clients; works with clients to identify new providers and locations.
  • Created a board to list all of the new Providers and their status.

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78 Providers Jobs

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2. Credential Files

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Here's how Credential Files is used in Credentialing Specialist jobs:
  • Maintain organized credential files and assists with inspections by regulatory authorities or accreditation surveyors.
  • Coordinated maintenance of Credential files and updated the Echo Database for Credentialing as necessary.
  • Compiled and presented completed credential files to Credentials Committee for approval.
  • Created credential files from initial information received from the Recruitment Department.
  • Maintained up-to-date provider and hospital site credential files.
  • Create credential files from initial information received.
  • Manage the maintenance and filing of critical physician and Allied Health Professional (AHP) credential files and documents.
  • Prepared individual credential files and established a physician profile in the medical staff computer system on each applicant.
  • Performed quality and peer reviews of credential files to ensure accuracy and adherence to policies and procedures.
  • Create and maintain all provider credential files to ensure all documents are current and in compliance.
  • Maintain credential files for all new coming Physicians, Nurses, Surgical Techs, etc.
  • Generated profiles and reports from Echo Database for Credentials Committee, and Credential Files.
  • Maintain Credential files on Medical and Allied Health Professional staff appointees.
  • Organized and maintained credential files for over 300 providers and facilities.
  • Assure the uttermost degree of confidentiality regarding providers' credential files.
  • Serve as record custodian/manager for over 300 provider credential files.
  • Provided day-to-day management of more than 200 nurse credential files.
  • Maintain, assemble and scan credential files for providers.
  • Maintain QA profiles and credential files with discretion.
  • Maintain credential files including updates and maintenance of information (e.g.

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9 Credential Files Jobs

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3. Medical Staff

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Here's how Medical Staff is used in Credentialing Specialist jobs:
  • Processed medical staff applications for credentialing and re-credentialing to determine competencies of medical staff for Health Plans according to plan specifics.
  • Collaborate with medical staff, risk units and other pertinent personnel to facilitate timely and efficient credentialing process.
  • Prepared Initial and Reappointment applications for Physician Privileging at client Medical Staff Offices for Sheridan Radiology.
  • Coordinated Medical Staff member hospital affiliation verification letters to outside sources.
  • Collaborated with CMO and Medical Staff leadership to ensure consistency in patient safety and stellar reviews by The Joint Commission.
  • Acted as liaison between Accounts Receivable (AR) and medical staff on an as-needed basis to maximize AR efforts.
  • Prepare credential files for completion and presentation to Medical Staff Committees, ensuring file completion within time periods specified.
  • Process paperwork for Medical Staff and Allied Health to obtain Identification badge with hospital security.
  • Interfaced with hospital medical staff offices, affiliates, and insurers to ensure correct processing.
  • Interacted directly with the Medical Staff Offices to obtain permanent and temporary privileges for practitioners.
  • Process request for Medical Staff and Allied Health identification numbers with IT department.
  • Verified the professional licensing, training, and certifications of professional medical staff.
  • Participate in the appointment process and coordinated medical staff meetings.
  • Coordinate the Medical Staff Committee meetings.
  • Review 40+ nursing and medical staffing time sheets for dates and shifts worked Calculate rates, overtime, sick time etc.
  • Perform specific functions pertaining to the Medical Staff credentialing process as assigned by the Administrative Director.
  • Expensed all applicable costs for reimbursement on behalf of medical staff and arranged travel to conferences.
  • Assisted in the coordination of all Medical Staff requirements, while providing secretarial support.
  • Enter all current verifications into the credentialing software and ensure accuracy Assist the medical staff with any missing documentation
  • Work collaboratively with hospital medical staff offices and PHOs/IPAs.

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45 Medical Staff Jobs

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4. Medical Malpractice

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Here's how Medical Malpractice is used in Credentialing Specialist jobs:
  • Studied and reviewed information on medical malpractice payments, adverse actions, active clinical privileges, and professional society memberships.
  • Completed, applied and maintained medical malpractice insurance for practice and employees.
  • Conducted detailed research in medical malpractice cases needed for provider credentialing.

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2 Medical Malpractice Jobs

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5. DEA

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Here's how DEA is used in Credentialing Specialist jobs:
  • Demonstrated flexibility and met deadlines.
  • Maintain spreadsheets and databases of all provider numbers, expiration dates, license numbers, DEA registrations, etc.
  • Verify and update DEA, license, board certifications, COI's in the Cactus software.
  • Assist in the Committee preparation which includes reporting, analysis, and meeting monthly deadlines.
  • Coordinated all renewal and continuation beyond appointments while working directly with the Dean's office.
  • Apply for and maintain provider NPI, License and DEA registrations.
  • Updated medical and DEA licenses and ran background checks.
  • Obtained medical and DEA licenses for ten providers.
  • License and DEA renewals or updates.
  • Meet daily and weekly deadlines.
  • Assure that all practitioners maintain current licensure, DEA certificates and professional liability insurance.
  • Deactivate provider numbers, effective dates, notification of deactivation status.
  • Research and obtain verification of clinicians' medical experience, professional references, state licensure, DEA, DPS, etc.
  • Traveled to hospital and physician offices to obtain signatures for various provider packets in order to meet deadlines and targeted goals.
  • Completed online verifications of NPDB, Board Certifications, State Licenses, DEA, Malpractice insurance, and OIG.
  • Track license, DEA, board certification and professional liability expirations for appointed ASC providers.
  • Ensured that deadlines are met and requirements satisfied in a timely manner.
  • Complete providers' files accurately while working under a short deadline.
  • Used internet to verify medical licenses, DEA, Certifacts, AMA, OIG, EPLS, and NPDB.
  • Meet time-sensitive deadlines and multi-task in a changing healthcare environment.

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1 DEA Jobs

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6. Primary Source Verification

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Here's how Primary Source Verification is used in Credentialing Specialist jobs:
  • Perform primary source verification for initial and re-credentialing of assigned providers utilizing NCQA Standards and other federal and state regulatory requirements.
  • Processed mortgage applications and performed credentialing verification with primary source verification (PSV) for all providers.
  • Provided primary source verification on appointment and reappointment, including national data bank queries, malpractice history.
  • Completed primary source verification based on the requirements of each provider.
  • Performed primary source verification for initial credentialing and reappointment applications.
  • Coordinated primary source verification of initial and reappointment applications.
  • Use software system to improve application process., * Obtain primary source verification of all information listed in application.
  • Produced, documented, and tracked primary source verification letters, including follow-up, second and third requests.
  • Conducted thorough background investigation, research and primary source verification of all components of the application file.
  • Assist with primary source verification, responding to BPI requests via email, fax, and phone.
  • Conduct primary source verification of all components of the application and documents.
  • Completed primary source verification on all providers for Credentialing and Recredentialing.
  • Conduct detailed background investigations and primary source verifications on providers.
  • Implemented credentialing standards which included primary source verifications.
  • Perform all required primary source verifications.
  • Processed all primary source verifications.
  • Obtain primary source verification of licensure, education and training, and specialty board certification via telephone, fax or online.
  • Oversee the primary source verifications and performs quality audits.
  • Performed primary source verifications (FACIS, OIG, NJ Debarment, EPLS, CertiFacts, FSMB, State license).
  • Maintained physician database and performed primary source verifications for appointments/reappointments.

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36 Primary Source Verification Jobs

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7. Ncqa

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Here's how Ncqa is used in Credentialing Specialist jobs:
  • Compiled and maintained orderly, updated provider credentialing and re-credentialing applications following NCQA guidelines.
  • Performed primary source verification required by NCQA Guidelines.
  • Evaluate ongoing assessment and oversight of the delegate's performance and compliance with delegated service agreement, state and NCQA standards.
  • Interact with sub-delegated CVO to ensure accurate and timely information is received for the Physician Credentialing file per NCQA guidelines.
  • Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc.).
  • Assist the Medical Staff in credentialing and granting of privileges per The Joint Commission and NCQA standards.
  • Maintain current up to date Medical Staff Bylaws per The Joint Commission and NCQA standards.
  • Reviewed credentialing files and ensuring for compliance with the NCQA standards prior to Committee review.
  • Regulate & Maintain the NCQA (National Committee for Quality Assurance) certification.
  • Conduct primary source verification of specified elements per NCQA and JACHO requirements.
  • Ensured providers had proper credentials and accreditation according to NCQA standards.
  • Preform off site physician/provider medical office reviews to NCQA standards.
  • Ensured national standards of quality by complying with NCQA requirements.
  • Designed an application and processing procedure per NCQA standards.
  • Follow NCQA and JCHO credentialing standards.
  • Participate in delegation and NCQA audits.
  • Received two NCQA 3 year accreditations through delegated credentialing for Medical Mutual of Ohio and Prudential.
  • Developed and maintained logs for re-credentialing of providers in accordance with NCQA and QISMC timelines.
  • Act as liason with network coordinators concerning practioners demographic and site information according to NCQA guidelines.
  • Undergo reliability audits on credentialing and recredentialing files using the NCQA audit tool.

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19 Ncqa Jobs

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8. Insurance Companies

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Here's how Insurance Companies is used in Credentialing Specialist jobs:
  • Initialized and tracked required applications for hospitals and insurance companies regarding faculty appointments and credentialing.
  • Complete Credentialing and Re-Credentialing applications for insurance companies; Monitor applications and follow-up as needed.
  • Function as a liaison between malpractice insurance company and property and liability insurance companies.
  • Work with representatives from various outside insurance companies to insure physician participation for reimbursement.
  • Obtained status updates for participating applicants via daily contact with various insurance companies.
  • Initial and re-credentialing applications for all insurance companies for all providers.
  • Ensured all clinical providers were credentialed with contracted insurance companies.
  • Maintained accurate and up to date fee schedules with the various insurance companies in order to ensure accurate reimbursement for services.
  • Complete initial credentialing applications for physicians, track applications, act as liaison between the doctors and the insurance companies.
  • Review provider application on CAQH, NPI to ensure compliance with hospital and insurance companies and completeness of credentialing.
  • Organized physician's individual files and keeping track of credentialing status with different insurance companies.
  • Provided services for the doctors whenever they were having problems with any insurance companies.
  • Facilitate communications between physicians, discharged patients, insurance companies and home care agencies.
  • Acted as a liaison between contracted provider group Office Managers and insurance companies.
  • Interact with insurance companies to support the credentialing process.
  • Set up provider's with participating Insurance companies.
  • Correspond with both hospitals and insurance companies.
  • Worked with insurance companies to enroll providers.
  • Communicate with insurance companies to credential all providers within Comprehensive Orthopaedics.
  • Check throughout the month with licensing boards, dea and insurance companies to ensure doctors' expirables are up to date.

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2 Insurance Companies Jobs

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9. Hospital Privileges

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Here's how Hospital Privileges is used in Credentialing Specialist jobs:
  • Performed follow-up with hospital medical staff offices and providers in order to expedite participation approval and hospital privileges.
  • Established 15 Orthopedic Surgeons insurance participation, medical malpractice insurance, and hospital privileges.
  • Help to facilitate and maintain hospital privileges, working directly with hospital credentialing counterparts.
  • Facilitate hospital in the collection of the necessary information to secure hospital privileges.
  • Verified hospital privileges, education/board certification, malpractice and medical licenses.
  • Verified education and hospital privileges, malpractice insurance and claim history.
  • Communicated clearly and effectively when requesting verification of hospital privileges.
  • Process initial and reappointment applications for providers requesting Hospital privileges.
  • Submitted to the payers/hospitals for provider enrollment and hospital privileges.
  • Received and reviewed initial credentialing applications and hospital privileges.
  • Complete Credentialing applications for hospital privileges and insurance companies.
  • Obtain Hospital Privileges for newly licensed providers.
  • Arrange hospital privileges and credentialing for providers according to client(s) medical staff rules and regulations or bylaws.
  • Process applications to obtain hospital privileges on behalf of new and existing providers as needed and maintain an accurate database.
  • Keep track of the provider's hospital privileges and requirements such as current TB test and flu vaccinations.
  • Verify Medicare/Medicaid sanctions, hospital privileges, malpractice history, insurance coverage, and perform NPDB queries.
  • Applied for medical licenses, DEA, apply for hospital privileges and updated physician credential database.
  • Handled applications for physicians who were applying for hospital privileges.
  • Verified physician credentials to ensure eligibility for hospital privileges and medical licensure, including DEA renewals.
  • Apply for the hospital privileges and maintaining the reappointments.

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8 Hospital Privileges Jobs

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10. Caqh

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Here's how Caqh is used in Credentialing Specialist jobs:
  • Enforced regulatory compliance and quality assurance by ensuring all provider information meets Massachusetts state guidelines when processing CAQH applications.
  • Collect and process significant amounts of verification and accreditation information using Cactus and CAQH ProView.
  • Review CAQH applications for practitioners for initial and reappointment Credentialing.
  • Indemnified all provider information remained up to date with individual in-network payers and CAQH on a monthly.
  • Initial credentialing and re-credentialing of doctors and all allied health providers using CAQH guidelines.
  • Review the CAQH system and download applications or supplemental documents as appropriate.
  • Utilize CAQH to pull provider information for initial credentialing as assigned.
  • Set up and maintained the Providers CAQH documentation.
  • Maintained CAQH database with quarterly review and attestations.
  • Download the credentialing and re-credentialing applications for CAQH.
  • Keep all documentation and information up-to-date in CAQH.
  • Maintain all CAQH files for all contracted providers.
  • Maintain practice information in providers CAQH database.
  • Create and update CAQH accounts.
  • Create and maintain CAQH accounts.
  • Performed ongoing CAQH data management Maintained and updated database to track applications within the credentialing process.
  • Provide credentialing for multi-specialty physicians, create physician profile and CAQH application.
  • Maintain CAQH, NPPES applications in a timely manner which expedited credentialing privileges.
  • Maintained CAQH Profiles, Development Letters, and State Licensure, etc.
  • used PECOS and CAQH for the credentialing process

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23 Caqh Jobs

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11. Health Care

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Here's how Health Care is used in Credentialing Specialist jobs:
  • Reviewed health care providers credentialing materials with special attention to timeliness and accuracy.
  • Processed credentialing and re-credentialing applications of health care providers.
  • Conduct credential/re-credentialing process for participating health care providers.
  • Schedule interviews with health care professionals (RN's, CNA's, and Technicians) for staffing at area hospitals.
  • Position included credentialing health care providers to obtain and/or maintain network affiliation with Blue Cross Blue Shield various health plans.
  • Communicate accurate, pertinent information to Patient Care Provider and other members of the health care delivery team.
  • Conducted online research and made phone calls to physician offices and health care sites to gather relevant information.
  • Make certain that everyone working at a health care facility is in compliance with state and federal guidelines.
  • Verify their health care facility, as a whole, complies with medical and insurance industry policies.
  • Designated to perform assignments at Prudential Health Care Plan, and Chase Bank of MD.
  • Consulted and credentialed health care providers of VA subcontractor and scheduled Veteran VA evaluations.
  • Responded to routine verification of membership and privileges inquiries from other health care facilities.
  • Reviewed applications for completion and key data into multiple health care systems for processing.
  • Maintain and /or create CAQH and NPPES accounts for multiple health care providers.
  • Gather information for health care facilities.
  • Lead Non-privileged Medical Coordinator for governmental health care providers * Credential privileged and non-privileged health care provider files for government contracts.
  • Processed credentialing and re-credentialing application of health care providers Reviewed and prepared verification letters and maintained databases.
  • Presented graduation information to Health Career students at Cuyahoga Community College.
  • Investigate the licensing status of the Health Care providers as well as the Healthcare Care facilities.
  • Ensured health care facility and it's staff 's credentials meet government and accrediting agency standards.

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18 Health Care Jobs

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12. Medicare

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Here's how Medicare is used in Credentialing Specialist jobs:
  • Ensured accurate information for the Medicaid-Medicare-NPPES crosswalk was consistent for claims processing.
  • Managed the Medicare Provider application process for four Optical divisions.
  • Submitted Medicare application and checked status of application.
  • Research and analyze Medicare Part B applications and determine correct actions needed to provide the best service to Medicare Providers.
  • Manage Medicare issues regarding PTAN number to each individual Provider (doctor, nurse, PA, therapist).
  • Maintained working knowledge of regulatory standards applicable to the practice of pharmacy and Medicare Part D.
  • Cooperated with Medicare, Medicaid and private insurance providers to resolve billing and credentialing issues.
  • Utilize PECOS, NGS Enrollment Application tool and several other credential tools for Medicare enrollment.
  • Initiated process of aligning the physicians with groups by completing Medicare 855I and 855R applications.
  • Establish Electronic Funds Transfer (EFT) of their Medicare Payments.
  • Prepared monthly Medicare Opt-Out, OIG, EPLS and TMA reports.
  • Research and submit EOB and RA denials for Medicaid and Medicare.
  • Updated all Policies and Procedures to be compliant with Medicare requirements.
  • Billed for Medicare, Medicaid and all commercial insurance carriers.
  • Schedule outpatient psychotherapy appointments & verify mental health eligibility via Magellan, Navinet & Ability(Medicare).
  • Coordinated closely with Medicare, Medi-cal and Public/Local Insurance Departs.
  • Process, maintain, and verify applications for Medicare Part A and Part B Enrollment.
  • Retrieved EOB remittance payments from Medicare, Optima/Aetna and applied to patient's account.
  • Verified and requested information for physicians using CAQH, ECFMG, Medicare and etc.
  • Credentialed over 45 physicians with various health plans, Medicare, FL Blue, Cigna, United Healthcare, etc.

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13 Medicare Jobs

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13. Medicaid

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Here's how Medicaid is used in Credentialing Specialist jobs:
  • Complete and submit applications for provider's enrollment in Medicare/Medicaid.
  • Secured ancillary group and individual provider Medicare and Medicaid numbers.
  • Verified and updated disclosure for Tennessee Medicare/ Medicaid.
  • Sanction activity verification by Medicare and Medicaid.
  • Interacted with providers and their staff in retrieving pertinent missing information for providers to be credentialed in Medicaid-based health insurance group.
  • Interfaced with physicians and medical staff to provide information on enrolling as a Medicaid HMO provider.
  • Completed provider s applications for Medicare, Medicaid, Blue Cross Blue Shield and other Insurances.
  • Ensured eligible physicians were knowledgeable on the terms and regulations associated with joining the Medicaid HMO.
  • Processed credentialing documents for Medicare, Medicaid, Railroad Medicaid and the Department of Labor.
  • Added CLIA to Medicaid new group locations as it related to the TIN conversion.
  • Credentialed new physicians and maintained CAQH re-attestation's, Medicaid re-attests, etc.
  • Inform and Educate Physicians on new NY State Medicaid and Medicare Regulations.
  • Credentialed general and specialty physicians into the Medicaid HMO plan.
  • Generated payment plans for self-pay and Medicaid pending patients.
  • Experience with Commercial, Medicare and Medicaid health plans.
  • Enroll all providers with Medicare and Medicaid.
  • Coordinated Doctors/Providers in various health insurances, primarily Medicare/Medicaid Handled and resolved billing inquiries.
  • Perform ongoing monitoring of Medicare and Medicaid sanctions and reinstatements.
  • Completed all Medicare/Medicaid enrollments, revalidations, and audits.
  • Researched and enrolled Medical Staff in out of state Medicaid plans as needed.

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14 Medicaid Jobs

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14. Data Entry

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Here's how Data Entry is used in Credentialing Specialist jobs:
  • Maintained credential database through ongoing data entry of practitioner updates with accuracy and in compliance of established integrity guidelines.
  • Maintained provider files of current professional licenses, certification through computer data entry.
  • Performed data entry of demographic patient information and billing
  • Performed extensive data entry and documentation.
  • General clerical responsibilities including, but not limited to; faxing, scanning, filing, data entry, etc.
  • Performed general office duties such as filing, photocopying and data entry.
  • Perform data entry corrections resulting from Visual Cactus system data audit reports.
  • Verified client third party insurance, obtained authorizations, data entry.
  • Assist Business analyst with Data integrity reports and data entry.
  • Perform data entry & image indexing for new providers.
  • Performed data entry duties with special attention to accuracy.
  • Accomplished at computer data entry.
  • Service CEO Data entry System.
  • Managed all data entry of credentials into microstaffer and submitted completed profiles and credentials to hospitals for approval.
  • Performed accurate and complete data entry of credentialing information in multi-site system environment.
  • Performed post committee data entry of credentialing status/decisions and comments.
  • Initial credentialing - Recredentialing - Handling mail and faxes - Data Entry
  • Trained co-workers in credentialing, recredentialing, and data entry.
  • Perform data entry into Teladoc Data Entry System.
  • Administered daily use of Symed database to maintain client information and delivered consistent data entry and Excel spreadsheet organization.

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15. Board Certification

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Here's how Board Certification is used in Credentialing Specialist jobs:
  • Verified medical training Internship/Residency Program and Medical Board Certification.
  • Verify and pull state licenses, board certifications/actions, malpractice claims, and all other required certifications pending state requirements.
  • Assist graduating fellows with board certification courses and all necessary credentials, reports and materials needed for their new assignment.
  • Conduct verification of current license, DEA and board certification through use of system resources and document the status.
  • Keep track of Board Certification, when eligibility runs out and boards are or have not been renewed.
  • Verified DEA, Controlled Substance License, Physician State License, Board Certification and Medicare/Medicaid Sanctions.
  • Maintain both databases with all changes of addresses, new board certifications, licenses, etc.
  • Board Certifications, Malpractice Insurance (Applied for insurance for providers as needed).
  • Verified State License, DEA, Board certification, etc.
  • Verify license, board certifications, and any malpractice claims.
  • Review DEA documents as well as board certifications.
  • Assure Board Certification is accurate and updated.
  • Perform primary source verification of licensure, board certification, DEA/CDS certificates, education and training verify employment experience.
  • Understand requirements of state licensure and board certification for applicants.
  • Collect and monitor Board Certification information to prepare and complete the credentialing section of the HEDIS Roadmap on an annual basis.
  • Performed online verification such as, Licensure, American Board Certification, and DEA - Department of Drug Administration.
  • Researched and obtained state licenses, DEAs, board certifications, and other pertinent documents renewals as appropriate.
  • Performed online verifications to ensure that physicians held current DEA, Licenses, Board certification and sanction reports.
  • Verify state licensures, board certifications, DEA registrations, and other certifications based on privilege requirements.
  • Verify appointment criteria such as licensure, training, board certification, and previous experience.

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11 Board Certification Jobs

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16. Customer Service

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Here's how Customer Service is used in Credentialing Specialist jobs:
  • Organized general office administration duties including filing, customer service for walk-ins and phone monitoring.
  • Provided customer service to internal business partners and dental provider offices.
  • Developed customer service training programs for Ambassadors and cafeteria staff.
  • Experienced Call-Center customer service representative and cashier.
  • Served as a customer service representative
  • Create and submit claims, claims status follow- ups, appeals, mail, customer service and receivables for the department.
  • Credentialed new providers into the TRICARE Network and afforded customer service to both external and internal customers * Maintained data compliance
  • Assisted network managers, customer service and provider offices with discrepancies with all provider data and claims processing issues.
  • Provide Exceptional Customer Service to providers who need assistance in filling out the appropriate forms.
  • Act as resource and subject matter expert for credentialing staff and customer service staff.
  • Act as customer service liaison to ensure that complex issues are resolved timely.
  • Assist in educating the credentialing team; problem solving and optimum customer service.
  • Provided excellent customer service to practitioners, managers, and team member.
  • Translated some forms from English to Spanish for the customer service department.
  • Job duties include maintaining and updating database, referrals and customer service.
  • Monitor Microsoft Office Outlook for provider requests and customer service requests.
  • Provided customer service to the physicians regarding the application process.
  • Tenured Customer Service Specialist, GC Service: Green Mountain Energy While working for GC Services I was a lead agent.
  • Provide excellent customer service to branch offices throughout the nation with detailed, organized notes.
  • Supported a dedicated Customer Service line for Provider Enrollment inquiries.

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1 Customer Service Jobs

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17. Ensure Compliance

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Here's how Ensure Compliance is used in Credentialing Specialist jobs:
  • Provided timely reports to practitioners, departmental chairmen, and committees regarding focused reviews to ensure compliance with all regulatory agencies.
  • Perform calculations, projections and assessments of client's family composition to determine eligibility to ensure compliance with regulations and guidelines.
  • Verify and document expired credential documents using acceptable verification sources to ensure compliance with accreditation and regulatory standards.
  • Process requests for privileges to ensure compliance with accreditation and regulatory standards.
  • Track and monitor credentials to ensure compliance with plan standards, accreditation agencies and state and federal regulatory guidelines.
  • Apply accepted principles, methods and guidelines to ensure compliance with verification and database input of the credentialing information.
  • Verified licenses and DEA education and forwarded completed files for auditing to ensure compliance with all NCQA standards.
  • Evaluate and monitor contract performance to ensure compliance with contractual obligations and to determine need for changes.
  • Conduct 6-month audit review to ensure compliance of all required documentation at time of renewal.
  • Performed annual delegation audit within one year of their next annual review to ensure compliance.
  • Conduct annual audit reviews of all delegated facilities to ensure compliance with ADHS/DBHS requirements.
  • Conduct file audits to ensure compliance and identification of soon to expire documents.
  • Incorporate recent State, Federal and Regulatory changes into Bylaws to ensure compliance.
  • Adhere to NCQA and URAC Credentialing Standards to ensure compliance and accreditation.
  • Maintain the schedule to ensure compliance with time-sensitive NCQA requirements.
  • Review all credentials submitted by candidate to ensure compliance.
  • Prepare files for managed care audits to ensure compliance.
  • Reviewed files to ensure compliance with National Committee.
  • Scheduled return visits to ensure compliance.
  • Educated staff on various aspects of coding practices to ensure compliance with all coding guidelines and policies.

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18. Health Professionals

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Here's how Health Professionals is used in Credentialing Specialist jobs:
  • Coordinated follow up with physicians and allied health professionals to assure accuracy and timeliness of information submitted to carriers.
  • Initiated functions relative to initial credentialing and re-credentialing for physicians and Allied Health Professionals in Lexington and Central Kentucky.
  • Credentialed Physicians, staff affiliates and allied health professionals for a multitude of hospitals managed nationwide.
  • Complete hospital medical staff applications for physicians and allied health professionals to obtain privileges at hospitals.
  • Provided credentialing education and software training to both physicians and allied health professionals.
  • Process all Medical Staff and Allied Health Professionals initial and re-appointment application.
  • Maintained credentialing services for over 3,500 national physicians and allied health professionals.
  • Maintained the database for approximately 1,000 physicians and allied health professionals.
  • Assist in development of job descriptions/functions, implemented processes currently used to credential Allied Health Professionals based on human resource standards.
  • Verify legitimacy of physicians and allied health professionals and ensure that they are in compliance with state and federal standards.
  • Prepare formal approval letters for incoming, promoted and reappointed Clinical Staff Members and Allied Health Professionals.
  • Create procedures for payer credentialing of physicians, allied health professionals to requirements for all payers.
  • Manage and direct Reappointment process of 900+ Physicians and 300+ Allied Health Professionals.
  • Scheduled more than 200 nurses and allied health professionals for mandatory health screenings.
  • Booked monthly meetings for credentials committee and allied health professionals.
  • Verified the accreditation of doctors and allied health professionals.
  • Set up new Physician and Allied Health Professionals files.
  • Performed credentialing responsibilities in an expeditious manner to bring on new physicians and allied health professionals.
  • Handled the credentialing and re-credentialing processes for applicants, members of the Medical Staff and Allied Health Professionals.
  • Maintain credential profiles and files (physicians' and allied health professionals').

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23 Health Professionals Jobs

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19. Npdb

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Here's how Npdb is used in Credentialing Specialist jobs:
  • Developed and implemented automated process for conducting NPDB queries.
  • Correspond with licensing board, NPDB, hospitals, certification agencies, training programs and medical groups to resolve any issues.
  • Requested the reports of actions, sanctions or malpractices through the NPDB (National Practitioners Data Bank).
  • Verify medical licenses, DEA license, control substance licenses, exclusions, NPDB and AMA profiles.
  • Perform ongoing monitoring of currency documents (Malpractice Insurance, DEA, NPDB and State license).
  • Work extensively with CAQH, NPDB and other national associations to ensure accurate provider data.
  • Processed Initial/Re-credentialed applications for individual, group and ancillary providers per CAQH, NPDB sites.
  • Verify physicians credentials on-line i.e., MBOC, OIG, NPDB, AMA Profiles.
  • Researched and prepared credential files through primary source verification and NPDB query.
  • Verify accuracy of background and credentials through NPDB & AMA queries.
  • Compare practitioner malpractice response on application with responses from NPDB.
  • Review Background check, which includes NPDB Sanction Report.
  • Verify provider credentials, boards and NPDB via website.
  • Maintained database system for credentialing to the NPDB.
  • Review any reported issues on NPDB.
  • Performed electronic queries (NPDB, AMA, FSMB, OIG, etc.)
  • Performed provider verifications using the National Provider Data Base (NPDB).
  • Order Self Queries from NPDB 6.
  • Perform primary source verifications for NPDB, EPLS, OIG, Licensures, and Board Certifications.
  • Request State Board verifications, loss reports, NPDB reports .

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13 Npdb Jobs

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20. Background Checks

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Here's how Background Checks is used in Credentialing Specialist jobs:
  • Administer personnel and contractor security files including background checks and identity documents.
  • Conducted background checks for all health care professionals while maintaining confidential information.
  • Check applicants against state misconduct data bases, run background checks on all new applicants and annually for current nurse contractors.
  • Send letters regarding expiring credentials including licenses, CPR, TB tests, annual drug screens and background checks.
  • Obtain medical and dental licenses, background checks, HIPAA, insurance and DEA information.
  • Background checks and malpractice claims and pending suites long with court ordered practicing stipulations.
  • Inspect and validate identity source documents, take fingerprints, verify background checks.
  • Coordinated orientation modules, drug screen requests, and administered background checks.
  • Perform background checks; obtain drug screen and immunization information.
  • Performed background checks to obtain candidates' criminal history.
  • Performed background checks on newly hired practitioners.
  • Conducted background checks, data entry.
  • Conduct background checks on various providers.
  • Process all criminal background checks.
  • Perform all necessary background checks.
  • Process criminal background checks; query AMA, National Practitioner s Databank and Education Commission for Foreign Medical Graduates databases.
  • Preformed physician background checks prior to hire and during service within the University of Pittsburgh Medical group of healthcare organizations.
  • Completed background checks, drug screens, reviewed licensure documents to ensure RN's eligibility to work.
  • Run background checks, verify training and licensure verification.
  • Process pre-employment background checks, field employee onboarding and terminations.

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21. Medical Licenses

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Here's how Medical Licenses is used in Credentialing Specialist jobs:
  • Processed and researched applications for state medical licenses submitted by dental personnel.
  • Aided providers in obtaining medical licenses and credentialing at numerous facilities.
  • Monitor and renew medical licenses and malpractice insurance.
  • Process Medicare applications, and re-new Medical Licenses, and DEA Certificate and NICA for members employed at LMC Centers.
  • Maintained occupational business tax licenses, medical licenses, and Drug Enforcement Administration (DEA) information for all providers.
  • Review Medical licenses, DEA, CDS, ACLS, BLS, and Malpractice insurance monthly for any expiration.
  • Keep organized files on the provider's certificates, education diplomas, malpractice insurances, and medical licenses.
  • Maintain up to date providers' database including medical licenses, certificates, Professional Liability Insurances, etc.
  • Applied for physician medical licenses and DEA for physician in Florida, Virginia, Kentucky and Louisiana.
  • Maintained all medical licenses, Drug Administrations, and malpractice insurance for physicians and mid-level practitioners.
  • Process all documents needed to credential/re-credential physicians including NPI number, DEA licenses, medical licenses.
  • Execute applications and track the process for new state medical licenses for providers.
  • Help with renewal of medical licenses, pharmacy and DEA certificates.
  • Maintain their medical licenses, insurance, DEA licenses etc.
  • Verify on-line status of all State Medical Licenses, State Narcotics
  • Update all provider medical licenses, malpractice insurance.
  • Verify all active and inactive medical licenses.
  • Verify medical licenses, board certification etc.
  • Maintained up-to-date physician database, including medical licenses, drug enforcement administration certificates and professional liability insurance.
  • Maintain all expirables including Medical Licenses, Malpractice insurance, etc.

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22. Committee Meetings

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Here's how Committee Meetings is used in Credentialing Specialist jobs:
  • Facilitated monthly/semi-monthly Credentialing Committee meetings.
  • Coordinated monthly Utilization Committee meetings to discuss results of audits and analysis and make recommendations.
  • Facilitate Joint Operations Committee meetings with delegated network groups.
  • Facilitated weekly network and monthly credentialing committee meetings.
  • Coordinated weekly AD HOC and monthly Credentialing Committee meetings and performed yearly site visits for affiliated hospitals.
  • Scheduled, prepared for, and facilitated the UST Medical Executive Committee and credentials committee meetings.
  • Prepared the credentialing and re-credentialing files for the Credentialing Committee meetings held once a month.
  • Prepare files for the Credentialing Committee Meetings Approval of Provider Participation into the Network.
  • Attended Board Committee Meetings to discuss potential issues that may hinder the enrollment process.
  • Host, conduct, and took the minutes for the credentialing committee meetings.
  • Booked monthly meetings for physician committee meetings and coordinated meeting dates with photographer.
  • Attend Performance Improvement Committee meetings and took minutes and transcribed them after meeting.
  • Prepare file for Credentials Committee & Medical Executive Committee meetings each month.
  • Organize and attend Credentialing Committee Meetings on a monthly basis.
  • Scheduled and attended department chair committee meetings.
  • Conducted and attended committee meetings.
  • Prepared weekly reports of credentialed files ; researching issue/problem files * Prepared agenda for the monthly Credentialing Committee meetings
  • Attended Monthly Credentialing Committee meetings.
  • Attended credentials committee meetings, prepared meeting agendas.
  • Assisted with contract negotiations of the Manage care plans Appointed to assist with monthly credentialing committee meetings.

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4 Committee Meetings Jobs

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23. Provider Applications

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Here's how Provider Applications is used in Credentialing Specialist jobs:
  • Reviewed all provider applications and supporting documentation for completeness, and oversaw data entry through assigning to Credentialing Specialists.
  • Processed provider applications and reapplications for participation in the CHA Networks using specialized software.
  • Review provider applications for completion accuracy and compliance with Joint Commission policies and procedures.
  • Completed provider applications for enrollment in Medicare, Medicare Railroad and Medicaid.
  • Performed analysis of initial provider applications submitted for health provider certification.
  • Received Managed Care and PPO provider applications and re-credentialing applications.
  • Process provider applications and contracts for credentialing committee review.
  • Review provider applications on CAQH for completeness of credentialing.
  • Receive and track approximately 800+ completed provider applications weekly.
  • Processed provider applications for privileging appointment and/or reappointment.
  • Review and process provider applications and credentials documents
  • Screened provider applications (included physicians, non-physicians and ancillaries) to ensure NCQA and Plan criteria was met.
  • Review and request on 200+ provider applications weekly while maintaining adherence to state TAT requirements.
  • Processed provider applications through the credentialing process for the resident staff.
  • Respond to inquiries regarding the status of provider applications.
  • Monitor and track statuses of provider applications.
  • Audited all provider applications for completeness and verified all date sensitive information (i.e.
  • Processed provider applications in a timely manner.
  • Review and process healthcare provider applications for enrollment in Commercial Health Plans.
  • contract) Receives provider applications and contacts providers for any additional supporting documentation or clarification.

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14 Provider Applications Jobs

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24. CMS

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Here's how CMS is used in Credentialing Specialist jobs:
  • Audited enrollment applications before submitted to CMS.
  • Provide compliance with the Centers for Medicare and Medicaid Services (CMS) regulations as well as internal procedures and protocols.
  • Identified all incomplete and complete agent eligibility in compliance with CMS regulations and PUP's policies and procedures.
  • Enroll new providers and update existing provider files using action reasons and review codes per CMS guidelines.
  • Implement and maintain CMS and State accreditation standards for the organization as related to medical staff.
  • Created and revised policies and procedures to meet CMS, DHCS, and NCQA requirements.
  • Registered organization to report as a GPRO for PQRS and avoid CMS penalty in 2016.
  • Researched all agent Elections Forms for completeness using all CMS regulations and time frame.
  • Processed multiple application types in accordance with CMS Part B Medicare standards.
  • Updated business rules and desk procedures to accommodate program changes from CMS.
  • Processed multiple Part B application types per CMS guidelines and regulations.
  • Monitor and ensure staff is within compliance guideline of CMS Policy.
  • Licensed 6 health care facilities with CMS 855B AHCA Health Care Clinic, CLIA, and HCCE state licenses.
  • Input information provided in CMS, communicating with Doctors, PA, RNs to get all the information up to date.
  • Verify and update the banking information reported on the CMS 588 (EFT Enrollment) form is correct.
  • Review HCMS and CIVS files for completed data on physicians and prospective providers for the healthcare plan.
  • Manage Provider's with AHCA, CMS, and Regulatory affairs standards through scheduled through contracts database.
  • Maintained excellent quality assurance ratings due to attention to detail and adhering to CMS guidelines.
  • Processed the CMS-588 EFT application submitted by providers who needed to revalidate their EFT information.
  • Process CMS enrollment, revalidation, and disenrollment applications, per CMS guidelines.

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25. Current State Licenses

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Here's how Current State Licenses is used in Credentialing Specialist jobs:
  • Maintain and monitor present provider credentialing files for current state licenses, professional liability insurance, and contract renewal.

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26. Jcaho

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Here's how Jcaho is used in Credentialing Specialist jobs:
  • Conduct credential/re-credentialing audit process for participating practitioners utilizing; JCAHO/NCQA standards.
  • Represented Hospital for Credentialing JCAHO audits.
  • Performed all the credentialing processes to maintain provider credentialing and re-credentialing applications to meet NCQA, JCAHO, and CMS requirements.
  • Assist with JCAHO Survey preparation for the Medical Staff/leadership function, including staff and Medical Staff education regarding accreditation standards.
  • Reviewed and processed physician credentialing applications while performing thorough background checks, ensuring adherence to JCAHO and NCQA guidelines.
  • Review and update procedures or quality assurance to ensure NCQA, JCAHO and URAC standards are being upheld.
  • Assured compliance with all standards and regulations including inspections by government agencies (JCAHO and CMS).
  • Implement activities that ensure compliance with NCQA, JCAHO, State, and Federal policies.
  • Credentialed physicians and allied health professionals according to JCAHO and NCQA standards.
  • Audited files for conformity with JCAHO, NCQA and CMS standards.
  • Ensured files complied with hospital bylaws, JCAHO and IDPH.
  • Maintain a working knowledge of JCAHO credentialing requirements.
  • Followed NCQA and JCAHO guidelines.
  • Complied with JCAHO and NCQA.
  • Track licensure, professional liability insurance, board certifications in accordance with state regulations and JCAHO requirements.
  • Supervised practitioner-credential documentation to successfully meet regulatory standards (JCAHO) for peer review and payor audits.
  • Received and reviewed initial and recredentialing credentialing applications following JCAHO and NCQA accreditation guidelines.
  • Assisted the Assistant Vice President of Credentialing in creating and implementing NCQA and JCAHO policies and procedures for a start credentialing department..
  • Performed on going focus and professional practice peer review per JCAHO standards on all physicians and allied health professionals.
  • Prepared application to meet JCAHO Standards.

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27. OIG

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Here's how OIG is used in Credentialing Specialist jobs:
  • Review federal and state Medicare OPT Out, OIG and SAM report for exclusions from the Medicaid or Medicare Programs.
  • Maintained month reports (Medicare & Medicaid Sanction/ OIG/ EPLS/Medicare opt-out list, Nursing Home Watch list).
  • Monitored NPDB, Medicare Opt-Out / LEIE / OIG / DOH / SAM and investigated federally imposed sanctions.
  • Used approved web tools (NPDB, OIG, State License sites) to verify provider credentials.
  • Maintained a re-credentialing database and verified providers' status updates (OIG and state board).
  • Monitored License, OPMC, and OIG sanctions, to ensure providers system was updated accordingly.
  • Monitor and research reports identifying practitioners for federal/state sanctions, OIG and board orders.
  • Monitor provider expiring credentials, license status, OIG, and EPLS reporting.
  • Perform NPDB, DEA, OIG/GSA, professional schooling, and board certification.
  • Process includes conducting queries from the OIG, Excluded Parties, Sex Offender, AMA, and NPDB.
  • Run various reports including OIG, SAM, CLIA and GAMMI.
  • Verified employment, DEA verification licensure, certification, education and National Practitioner Data Bank OIG/GSA.
  • Verify all professional licensures, registrations, certifications, malpractices insurances, clinical privileges, EPLS, OIG & NPDB.
  • Performed on-going monitoring of Licenses, Sanctions, Medicare Opt-Out, OIG and quality of care as directed.
  • Conduct licensure, OIG and GSA verification for any suspensions or legal action.
  • Call on Hospitals and Healthcare Facilities to obtain references for Nurses, Run reports: OIG, GSA and Nursys.
  • Enroll Anesthesiologists and CRNA's into managed care health plans Verifying MD licenses/OIG Report Maintain Cactus database
  • Review new provider credentials for on-boarding Run OIG and SAM verifications.
  • Perform background checks by verifying OIG, NPDB, Kroll NJ State Debardment and NPI.
  • Complete background checks via Certiphi, E-Verifile, OIG, EPLS, Sex Offender sites Process and maintain new hire profiles.

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28. Medical Staff Bylaws

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Here's how Medical Staff Bylaws is used in Credentialing Specialist jobs:
  • Process initial and re-enrollment applications for employed and contracted providers according to the Medical staff bylaws and credentialing policies.
  • Ensured compliance with Medical Staff Bylaws and regulatory requirements flagging any issues identified during the credentialing process.
  • Monitored proctoring of provisional staff members according to medical staff bylaws and department rules and regulations.
  • Assisted in interpretation and enforcement of Medical Staff Bylaws and provided guidance when necessary.
  • Coordinate temporary/emergency privileges per Medical Staff Bylaws.
  • Coordinated the process of credentialing and privileging of the Medical Staff according to the Medical Staff bylaws, Rules and Regulations.
  • Process medical staff and allied health initial and reappointment applications for membership and privileges in accordance to the medical staff bylaws.
  • Assist in interpretation and enforcement of Medical Staff Bylaws, Joint Commission standards, and provide guidance to the Medical Staff.
  • Assist Department Chiefs and Committee Chairmen in carrying out of their responsibilities in accordance with regulatory requirements and medical staff bylaws.
  • Maintained physician license, DEA and professional liability status to coincide with the Medical Staff Bylaws and Rules and Regulations.
  • Review and thoroughly evaluate applications in accordance with Medical Staff Bylaws, Rules and Regulations and Joint Commission standards.
  • Serve as liaison between Credentialing Department and facilities to assist with education of and compliance with Medical Staff Bylaws.
  • Have current knowledge of medical staff bylaws rules and regulations, policies and procedures, JCAHO standards.
  • Advised medical staff on medical staff bylaws, rules and regulations, and policies and procedures.
  • Prepare appropriately all reappointment applications in compliance with deadlines required by the Medical Staff bylaws.
  • Ensured Joint Commission standards were captured, regulated and enforced in Medical Staff Bylaws.
  • Know interpret and implement policies and procedures outlined in the Medical Staff Bylaws.
  • Implement Medical Staff Bylaws changes to adhere to The Joint Commission standards.
  • Explain and interpret Medical Staff Bylaws and Rules and Regulations where appropriate.
  • Complete all online verifications for all packets (NPDB/License/OIG/EPLS) Follows Medical Staff Bylaws, Network Credentialing Policies and other regulations.

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29. NPI

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Here's how NPI is used in Credentialing Specialist jobs:
  • Acquire and maintain provider's CDS, DEA, & NPI registration documents, verification, & related information as necessary.
  • Reviewed background investigation, researched and primary source verified and reviewed NPI numbers for all providers on the roster.
  • Maintain provider NPI and credentialing file, Load new providers into database, Track and verify receipt of applications,
  • Assisted billing staff as necessary regarding NPI, PECOS enrollment, claim issues and other enrollment discrepancies.
  • Follow the guideline and the escalation process, email alerts, and apply for NPI and CAQH.
  • Applied for National Provider Identifier (NPI) numbers and malpractice insurance for providers and extenders.
  • Applied for all NPI numbers for individual providers and the new clinics.
  • Assisted physicians in applying for their Medicare, Medicaid and NPI.
  • Collect the NPI type 2 for Credentialing a Group Practice.
  • Processed new NPI numbers for providers, organizations and facilities.
  • Experienced in obtaining NPI numbers and updating NPI information.
  • Set up NPI for each group and provider.
  • Update CAQH applications, NPI and liability insurance.
  • Apply for NPI numbers for new providers.
  • Apply and update the NPI website.
  • Maintain NPI record and make any updates necessary Extensive experience in working with Medicare, Medicaid and commercial insurance enrollment
  • Maintained the provider payor information NPI, Medicare, Medicaid, and PTAN numbers.
  • Monitored, and maintained multiple databases including credentialing, CAQH profiles, OQMHP employee trainings, APS logins and NPI numbers.
  • Maintained all provider files (CAQH, NPI, Databank, hospital privileges, Liability Insurance, etc.)
  • Complete Individual/Group NPI verifications using NPPES - Complete OIG/SAMS verifications for all dentist and associates.

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30. Reappointment Applications

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Here's how Reappointment Applications is used in Credentialing Specialist jobs:
  • Submitted complete credentialing materials to the Administrator of each department and flags any concerns for initial appointment and reappointment applications.
  • Processed new hire documents, reappointment applications, performance appraisals, collaborative agreements and delineation of privileges forms.
  • Worked on processing initial and reappointment applications for physicians/allied health physicians for my specified hospitals.
  • Submitted new incoming and reappointment applications requests to providers and update database as appropriate.
  • Collected/analyzed data from various sources to include with the initial and/or reappointment applications.
  • Process all initial/reappointment applications for Provider's to obtain hospital privileges
  • Processed initial and reappointment applications electronically on deadline.
  • Processed initial and reappointment applications for the group in order to gain privileges with hospital and nursing home facilities.
  • Review for accuracy and completeness; verify initial or reappointment applications (defined by client).
  • Complete credentialing and reappointment applications to be mailed to payers and facilities on behalf of providers.
  • Process initial and reappointment applications for MD's, DO's and AHP professionals.
  • Process Initial and Reappointment applications from practitioners seeking positions in Medical and Allied Staff.
  • Initial Physician applications were also constant and worked in with the reappointment applications.
  • Implement and maintain the Online Application Module for initial and reappointment applications.
  • Prepare and process reappointment applications for Medical Staff Members.
  • Track and log Credentialing Reappointment Applications.
  • Process all initial and reappointment applications for providers, Communicate with providers and hospital medical staff offices to meet deadlines.
  • Processed the applications and reappointment applications, also ran verifications on all licenses and boards.
  • Process reappointment applications for providers to obtain priviledges in the Detroit medical center.
  • Coordinated The National Plastics Fellowship Match-up Primary Source Verification of fellow, initial and reappointment applications Training New Hires

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31. Special Projects

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Here's how Special Projects is used in Credentialing Specialist jobs:
  • Assisted manager in special projects to develop and implement activities related to corporate standards and accreditation.
  • Provided support to management, including reports, special projects and other duties as assigned.
  • Provided the required leadership, support and direction for office initiatives and special projects.
  • Worked with Human Resources for urgent appointments and assisted on special projects as needed.
  • Expected to assist with special projects depending on the region.
  • Updated credentialing databases and managed special projects within the team.
  • Complete special projects of other duties as assigned.
  • Assisted supervisory staff with special projects as requested.
  • Support Director with special projects and tasks.
  • Performed special projects and duties as assigned.
  • Participate in special projects as needed.
  • Assisted manager in several special projects.
  • Work on special projects as assigned.
  • Created binders for special projects.
  • Completed special projects as needed.
  • Assist management with special projects.
  • Completed special projects, such as auto load requirements, in a timely manner.
  • Identify new payors to determine if credentialing is needed before patient is seen Performs special projects for department director as directed.
  • Prioritize daily task and complete in a timely manner * Assist team lead with special projects.
  • Start licensure process, prepare PTs to take the NPTE exam, set up test dates, special projects for VP.

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32. Committee Review

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Here's how Committee Review is used in Credentialing Specialist jobs:
  • Prepared information for Credentials Committee review and recommendation to the Medical Executive Committee.
  • Process reappointment applications in preparation for Credentials Committee review.
  • Facilitated practitioner privileging process and presented for committee review.
  • Prepare documents for Credentialing Committee review.
  • Prepare documents for committee review to report Credentialing activities, Adverse Actions, Delegation oversight, and Facility Site Review activities.
  • Communicate with applicants regarding the status of applications and Track all applications from receipt to Committee review and decision.
  • Audited and submitted completed files to the CVO for committee review and approval.
  • Research and summarize provider s malpractice and sanction history for Credentialing Committee review.
  • Prepared provider's documents for Chief Executive Officer and Board Committee review accordingly.
  • Prepare and review practitioner files for Credentialing Committee review and decisions.
  • Level two/level three summaries for committee review and approval or denial.
  • Submitted completed provider files for committee review within required time frames.
  • Prepare practitioner files for committee review and two-year mandatory review.
  • Build file documentation and prepares file for credentialing committee review.
  • Prepared provider's paperless file for Credentialing Committee review.
  • Prepare documents for Credentialing Committee review and Medical Board.
  • Prepare files for audits and Credentialing Committee review.
  • Prepare unclean files for credentialing committee review.
  • Prepare documents for Credentialing Committee review, Perform credential verification and request information from appropriate data banks.
  • Prepare paperwork for committee review for issue providers in a timely manner.

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33. Practitioner Data

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Here's how Practitioner Data is used in Credentialing Specialist jobs:
  • Verified State licenses, Board Certificates using National Practitioner Data Bank Report, online verification of medical licenses.
  • Supported manager by coordinating special projects in connection to practitioner recruiting and oversight of practitioner data integrity.
  • Assisted Team Leader with National Practitioner Data Bank project, to ensure accurate provider liability insurance reviews.
  • Collect and maintain an accurate practitioner database and analyze all verification information.
  • Verified information related to malpractice insurance utilizing National Practitioner Data Bank.
  • Maintained and updated all practitioner databases.
  • Compile and maintain current an accurate data for all providers and verify current practitioner data against various databases.
  • Submit and retrieves National Practitioner Database (NPDB) reports in accordance with Health Care Quality Improvement.
  • Upgraded practitioner databases after analyzing credentials files and ran reports for potential red flags.
  • Run queries of various state medical boards and the National Practitioner Data Bank.
  • Process queries to the National Practitioner Data Bank and Medical Board of California.
  • Check all new hires against National Practitioner Data Bank (NPDB).
  • Verified physician licenses via BPR On-Line and the National Practitioner Data Bank
  • Assisted with the creation and implantation of a new practitioner database.
  • Complete queries in the National Practitioner Data bank and HIPDB.
  • Maintained practitioner database * Monitored and notified providers of upcoming expiring documents.
  • Perform verifications and request information from appropriate data banks such as the National Practitioner Data Bank (NPDB) and OIG.
  • Job Duties: 1. Review files for malpractice cases, State Board action, National Practitioner Data Bank information 2.
  • Used the Council for Affordable Quality Healthcare (CAQH) system to submit practitioner data as required by providers/payers.
  • Accessed the National Practitioner Data Bank for all initial appointments, reappointments.

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34. Hipaa

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Here's how Hipaa is used in Credentialing Specialist jobs:
  • Developed and implemented training and educational activities necessary to organizational requirements as required by HIPAA confidentiality policies.
  • Maintain strict confidentiality of employee and organizational information in accordance with HIPAA and State privacy regulations.
  • Comply with HIPAA regulations to ensure confidentiality for technologists and facilities.
  • Maintained patient confidentiality and followed HIPAA Guidelines.
  • Assisted in the training of new hires and participated in staff workshops, such as HIPAA training.
  • Ensured adherence to HIPAA standards while providing customer service during the credentialing and re-credentialing processes.
  • Maintain current credentials for all active providers and comply with all HIPAA/JCAHO rules and regulations.
  • Coordinated meetings with other markets weekly regarding compliance with HIPAA's policies and procedures.
  • Trained new employees on HIPAA and OSHA safety regulations Credentialing Duties:.
  • Insured all claims information were processed in a HIPAA compliant manner.
  • Follow compliance and all HIPAA regulations, maintaining PPI and PHI
  • Maintain provider files in accordance to Army regulations and HIPAA.
  • Adhere to all HIPAA and Davis Vision privacy policies and procedures
  • Organize and gather staff and business agreements for HIPAA.
  • Followed all confidential and HIPAA guidelines as required.
  • Handle sensitive information in compliance with HIPAA.
  • Coordinated and maintain HIPAA training files.
  • Trained and compliant in HIPAA laws.
  • Adhere to HIPAA privacy regulations.
  • Ensured highest security and protection of private health information following HIPAA and state guidelines.

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35. Office Staff

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Here's how Office Staff is used in Credentialing Specialist jobs:
  • Cultivated strong business relationships with the Central Verification Office and Medical Staffing Office staff at several individual boards and hospitals.
  • Communicated with physicians and their office staff, hospitals and other provider organizations to provide primary source verification.
  • Liaised with facilities' office staff to obtain omitted information required for successful, expeditious credentialing.
  • Maintained communication with physicians and office staff on application status verbally and in writing.
  • Work closely with physician/provider and office staff to assure timely completion of applications.
  • Establish and maintain relationships with participating Medical Professionals and their Office Staff.
  • Developed and maintained close working relationships with Provider Representatives, Medical Societies, Medical Staff Office staff and state agencies.
  • Educated physicians and physician office staff on the credentialing process and maintains ongoing contact with these individuals throughout the process.
  • Communicated with providers or office staff and walk them through the application and update process and requirements.
  • Communicate & coordinate any updates, meetings or other information to all nurses and office staff.
  • Work directly with physicians and office staff to perform the credentialing process for the physicians.
  • Established trust and rapport with hospital staff, physicians, and physician office staff.
  • Handled physician concerns via telephone and worked with their office staff.
  • Provided technical support to office staff of 22 employees.
  • Provide quality service to Practitioners and/or office staff.
  • Assisted with the training of front office staff.
  • Key Contributions Established and cultivated productive working relationships with practice administrators, office staff and other support personnel to expedite completion.
  • Established relationships and effective communication with office managers, office staff and insurance representatives to ensure credentialing deadlines are met.
  • Provided billing/office staff with a list of current commercial healthcare contracts along with the current and previous rates of reimbursement.
  • Retrieve confidential documents Review applications Communicate with office staff Attach documents and complete files

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36. Malpractice Coverage

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Here's how Malpractice Coverage is used in Credentialing Specialist jobs:
  • Submitted and coordinated all credentialing documents including faculty appointment, medical staff appointment, malpractice coverage and additional credentialing documents.
  • Verified medical malpractice coverage and pulled reports from the National Practitioners Data Bank on providers to verify malpractice claims.
  • Maintained proper verification of all medical licenses, narcotics registrations, malpractice coverage and anything related to their credentialing.
  • Submitted applications to malpractice carrier for review and approval of malpractice coverage.
  • Initiated, arranged and maintained malpractice coverage for physicians.
  • Maintain appropriate level of malpractice coverage for clinical fellows.
  • Obtain and provide information regarding malpractice coverage.
  • Collaborate with insurance brokers to maintain expected malpractice coverage for all physicians and providers, making sure all required limits fulfilled.
  • Maintained copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  • Reached out to insurance carriers, and medical schools to verify previous malpractice coverage and to assign new coverage.
  • Obtained licensing, malpractice coverage, and hospital admission privileges to verify that all information was current and accurate.
  • Maintained copies of current state licenses, DEA, malpractice coverage other credentialing documents for medical staff.
  • Worked with general care and specialist physicians to ensure that their malpractice coverage was adequate.
  • Maintain copies of current state licenses, DEA certificates, and malpractice coverage.
  • Maintain state licenses, DEA certificates, malpractice coverage, and provider contracts.
  • Initiate the process for insuring malpractice coverage for all contracted providers.
  • Consulted with Centegra Health System to assure malpractice coverage and documentation.
  • Initiate the process of insuring malpractice coverage for all contracted provider Ensure all needed documentation is on file for contracted providers.
  • Obtain and maintain malpractice coverage, DEA Registration and Medical Licensure as applicable.
  • Coordinated licensure and malpractice coverage for 60 providers in group.

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37. Phone Calls

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Here's how Phone Calls is used in Credentialing Specialist jobs:
  • Document all tasks, phone calls, emails and other forms of communication during the enrollment process in the database.
  • Handled and processed an average of 150 outbound and inbound phone calls daily regarding provider follow- up and document accuracy.
  • Managed incoming phone calls, front desk reception, interacted with physicians, administrators, and occasional patients.
  • Conduct phone calls and emails with physicians, clinics, providers, medical facilities and health plans.
  • Make follow-up phone calls for requested information on Degrees, Internship, Residencies, and Fellowships.
  • Make routine phone calls to providers to update their information in company's referral system.
  • Handled an average of 150 daily phone calls requesting status of applications or provider issues.
  • Contacted provider offices for missing/expired information by email, fax and phone calls.
  • Answered credentialing or billing inquires and made follow-up phone calls to participating providers.
  • Prepare meeting agendas, notices/packets and making phone calls regarding Medical Staff meetings.
  • Perform outreach to providers and facilities via phone calls and fax/email correspondence.
  • Communicate with PBM's and Pharmacies through email and phone calls.
  • Answered all phone calls and resolved issues if possible.
  • Receive incoming phone calls from retirement plan participants.
  • Answered phones, made follow- up phone calls/emails.
  • Follow up phone calls on 30 day letters.
  • Mass mailing, correspondence and phone calls.
  • Researched physician back grounds to verify their education Verified through phone calls, mailings, official web sites
  • work with Microsoft word, copy, scan, fax, make phone calls.
  • Screened and responded to incoming telephone calls from provider offices and internal Univera department.

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38. CME

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Here's how CME is used in Credentialing Specialist jobs:
  • Coordinated travel arrangements for physicians to attend Continuing Medical Education (CME) seminars and maintained all CME documentation in database system
  • Manage and administer the programs CME accredited education programs/Conferences.
  • Developed promotional materials for CME events.
  • Hired for billing doing charge entry and account follow up then recruited to take over the CME Coordinator position.
  • Monitored, cataloged and submitted CME credit hours for all the providers in the practice.
  • Maintained and provided current hospitals, insurance, CME Credits, and malpractice insurance information.
  • Obtain information and schedule physicians for CME courses, symposiums, meetings and conferences.
  • Conducted verification for physician DEA, license renewal, scheduled CME seminars.
  • Coordinate necessary conferences and didactic teachings as defined by the AGCME.
  • Maintained Emergency Department and ICU requirements for yearly Stroke CME requirements.
  • Maintained CME's for each medical personnel.
  • Maintain the current documents and CME credits.
  • Assist physicians with CME tracking.
  • Updated providers medical education (CME) credits and all other pertinent data based on forecasted expiration dates.
  • Verify the education, training, licensure, CME, ACLS/BLS, and other required documents.
  • Complete physician and nurse licensing applications, CME verifications, and renewals for multiple states.
  • Record information in MD staff to assure doctors get CME credit.
  • Maintain Curriculum Vitae 's & CME information renewals for physicians.
  • Promoted to CME Program Manager in April, 2012.
  • Coordinated the reaccreditation process for the CME program at Swedish Covenant Hospital that led to reaccreditation in 2009 and in 2013.

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39. Nurse Practitioners

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Here's how Nurse Practitioners is used in Credentialing Specialist jobs:
  • Assisted with the insurance reimbursement process/credentialing of psychiatrists and nurse practitioners with private insurances, Medicare and MaineCare/Medicaid.
  • Contracted to military hospital as credential coordinator for all Pediatricians, Nurse Practitioners and Clinical Pharmacist.
  • Compiled complete and accurate credentialing files for physicians, nurse practitioners and physician assistants.
  • Initial credentialing/re-credentialing nurse practitioners, physician assistants and physicians.
  • Verify license for any sanctions; enroll Nurse Practitioners with payers according to the market they are working in.
  • Received signed contracts and checklists from physicians, And nurse practitioners Assessed information as current, verified with providers.
  • Print and obtain signatures on all client hospital applications for new physicians, nurse practitioners and physician assistants.
  • Verified DEA and medical license for all physicians, did nurse protocols for all the nurse practitioners.
  • Assisted with the development of new Clinical Privilege Descriptions for Physician Assistants and Nurse Practitioners.
  • Secured the registration of Medicaid and the clearance of malpractice for Nurse Practitioners.
  • Work with state to state protocols for Nurse Practitioners and Physician Assistants.
  • Process reappointment applications for physicians, physician assistant, and nurse practitioners.
  • Updated providers, nurse practitioners, professional counselors CAQH applications.
  • Interacted with Physician Assistants, Nurse Practitioners for Document Review.
  • Manage Private and Confidential files for 45 Neonatal Nurse Practitioners:
  • Maintained reappointments for all medical doctors, professional counselors, nurse practitioners with their hospitals affiliations.
  • Created daily Excel spreadsheets for Nurse Practitioners Physician Assistants on their active or non-active status with Medicaid.
  • Process license applications in a timely manner for Physicians and Nurse Practitioners.
  • Completed licensure and certification applications for all incoming physicians, physician assistants, and nurse practitioners with all contracted payors.
  • Apply for TMLT/TMIC (insurance) coverage for new physicians, PAs, Nurse Practitioners, and CRNAs.

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40. Accurate Data

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Here's how Accurate Data is used in Credentialing Specialist jobs:
  • Maintained credentialing database to reflect accurate data, current board certification and updated licensing and certifications for all allied health practitioners.
  • Maintained accurate provider data in the provider database and other applications through accurate data entry and verification as necessary.
  • Coordinate and provide accurate data entry information regarding providers, on our billing office/ lab information systems.
  • Identified problems with inaccurate data in the credentialing systems and produced a comprehensive medical staff roster.
  • Collect and process accreditation information, and maintain /update accurate databases for both practitioners and facilities.
  • Processed applications for completeness and accuracy and maintained accurate database for practitioners and facility.
  • Ensured accurate database management for over 300 providers.
  • Maintain accurate database of physician credentialing information.
  • Maintained database and filing records to ensure that current and accurate data gathered through credentialing process is updated.
  • Compile and maintain current and accurate data and credentialing files for 16 physicians and 10 allied health providers.
  • Enter and maintain accurate data on all initial faculty health professionals in the credentialing database.
  • Maintained timely and accurate data entry for practitioners in MD-Staff (credentialing database).
  • Managed credentialing database to ensure accurate data is updated and on file.
  • Review, complete and maintain all accurate data for credentialing providers.
  • Maintain and update accurate databases for both practitioners and facilities.
  • Compiled and maintained current and accurate data for all providers.
  • Processed provider credentialing and re credentialing applications Compiled and maintains current and accurate data for all providers.
  • Input accurate data into modules and websites using format consistent with pre-established guidelines.
  • Validate accurate data entry and assist with maintenance of On-going Monitoring Program.
  • Conduct Audits Complies and maintain current and accurate data for all providers.

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41. Ensure Accuracy

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Here's how Ensure Accuracy is used in Credentialing Specialist jobs:
  • Generate and maintain credential files, organizing documents to ensure accuracy and proper implementation of all privacy standards.
  • Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
  • Collect all needed physician signatures on applications and ensure accuracy and completeness of information.
  • Reviewed provider participation rosters to ensure accuracy and compared information to the FGP database.
  • Forwarded applications to providers to ensure accuracy and completeness of all information.
  • Work closely with Database Management to ensure accuracy of Provider Demographic Information.
  • Perform quality review of co-worker files to ensure accuracy and completeness.
  • Review and analyze provider paperwork to ensure accuracy.
  • Assisted the providers and facility managers with the application process to ensure accuracy prior to submitting to payers.
  • Communicate with other Network staff to ensure accuracy of rates and reimbursement to provider.
  • Review claims and data to ensure accuracy and make corrections to meet compliance guidelines.
  • Audited student's degree plan to ensure accuracy with prior learning.
  • Update and maintain CACTUS database to ensure accuracy and integrity.
  • Perform Quality Assurance for colleagues to ensure accuracy.
  • Performed audits of database reports to ensure accuracy of database information both internally and externally.
  • Utilized appropriate database tracking reports to ensure accuracy and thoroughness of data entry.
  • Maintained files of each individual candidate to ensure accuracy in the credentialingprocess.
  • Checked all applications to ensure accuracy to become Humana patient providers.
  • Enrolled providers into the network * Made outbound calls to providers to ensure accuracy * Took inbound calls from providers
  • Serve as liason between payors and third party administrators to ensure accuracy of all reports.

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42. Medical Records

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Here's how Medical Records is used in Credentialing Specialist jobs:
  • Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
  • Provide insurance companies medical records and itemized statements as needed.
  • Handle customer service calls regarding patient accounts, EMR (electronic medical records) and all other duties as they arise.
  • Conducted visits to primary care physician's facilities: inspected medical records, fire safety, and overall condition of facilities.
  • Organize or work with detailed medical records, using computers to enter, access, search or retrieve data.
  • Communicated with medical records departments at the hospitals where privileges had been granted to ensure compliance with JCAHO requirements.
  • Request and obtain medical records, notes, and/or detailed bills as appropriate to assist with research.
  • Research any negative past history in physician s medical records, obtaining all pertinent information for review.
  • Spearheaded training encompassing data entry, medical records, facilities management, and office procedures.
  • Reviewed, evaluated, and processed medical records, background check results, and certifications.
  • Accessed complaint, quality of care and medical records databases for Quality/Peer Review summaries.
  • Educate physicians on Electronic Medical Records (Paragon software by McKesson).
  • Fill in for positions such as Authorization and Medical Records when necessary.
  • Receive and process medical records requests from insurance companies and from patients
  • Review patients medical records to ensure state and government guidelines.
  • Work closely with HIM on delinquent medical records.
  • Process all request for medical records.
  • Collaborated with Quality Management, Medical Records, Business & Provider Affairs and Contracting to ensure timely dissemination of practitioner information.
  • Maintain and input the providers into the Meditech Electronic Medical records system of the hospital.
  • Created medical records database to monitor physician's compliance.

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43. Physician Assistants

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Here's how Physician Assistants is used in Credentialing Specialist jobs:
  • Documented complaints registered by patients against doctors* Prepared packets for board meetings; reviewed and maintained applications and files for physician assistants
  • Initiate and complete credentialing process for new and established physicians, physician assistants, occupational and physical therapist.
  • Credentialed and re-credentialed physicians, physician assistants, and therapists with contracted plans and facilities.
  • Facilitated the credentialing of 13 Physicians, 8 Physician Assistants & 4 Physical Therapists.
  • Maintain the credentialing of all the physicians and the physician assistants in the practice.
  • Maintained 15 Orthopedic Surgeons and 5 Physician Assistants surgical responsibilities in 4 hospital sites.
  • Authorize all surgeries and injections for 6 full-time surgeons and 2 physician assistants.
  • Applied for Supervision Prescriptive Delegation via TMB for new Physician Assistants.
  • Fielded urgent telephone calls to surgeons / physician assistants.
  • Verify physicians, physician assistants and other healthcare professionals' credentials for various government contracts.
  • Process medical licensure applications for physicians, physician assistants and nurses.
  • Credentialed surgeons, physician assistants and CFAs, and facilitated the move of our hospital offices to private office space.
  • handled the credentials for all emergency room physicians and physician assistants.

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44. External Customers

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Here's how External Customers is used in Credentialing Specialist jobs:
  • Facilitated interdisciplinary work groups to develop and implement strategies for overall credentialing process improvements with both internal and external customers.
  • Assist and determine practitioner issues and/or triage appropriately, via verbal/written communication in response to both internal and external customers.
  • Produced provider and facility contracts, identified, researched and resolved systems issues working with internal and external customers.
  • Worked closely with internal and external customers to ensure initial and reappointment applications were completed accurately and by deadline.
  • Provided exceptional customer services to internal and external customers by promoting open communication and exceeding their expectations.
  • Worked independently with internal and external customers to research and resolve credentialing-related issues.
  • Respond to calls for internal business and external customers regarding status of applications.
  • Developed and maintained professional, productive relationships with all internal and external customers.
  • Assist internal and external customers regarding status inquiries or complaints and facilitate resolution.
  • Compose written correspondence and engage in verbal communication with internal and external customers.
  • Responded to telephonic and electronic requests from internal and external customers.
  • Communicated effectively with internal/external customers to maintain customer loyalty.
  • Utilized effective communication to internal and external customers.
  • Communicate effectively with internal and external customers
  • Provide excellent customer service to both internal and external customers to ensure fair and profitable return for 25 physician practice.
  • Conduct research on escalated inquiries for both internal and external customers.
  • Forged strong relationships with internal and external customers that aided in the obtainment of required information in a timely manner.
  • Responded to inquiries from other healthcare organizations; interfaced with internal and external customers on credentialing and privileging issues.

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45. Commission Standards

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Here's how Commission Standards is used in Credentialing Specialist jobs:
  • Well-versed in primary source verification, communicating with insurance companies and maintaining policies and procedures according to The Joint Commission standards.
  • Perform primary source verification and data collection of all required documentation according to Joint Commission standards.
  • Gathered and organized information to credential providers in accordance with Joint Commission standards.
  • Performed credentialing verification in compliance with Joint Commission standards and state/federal laws.
  • Follow VA and Joint Commission standards and regulations while having providers meet deadlines so that they renew privileges prior to expiration.
  • Processed and maintained credentialing in accordance with NRS policy and procedure, Joint Commission standards and state and federal regulations.
  • Obtained and organized candidate credentials efficiently to ensure the office was in compliance with Joint Commission standards.
  • Maintain compliance with federal and state laws, regulations, Joint Commission standards and contractual obligations.
  • Maintained credentialing database, auditing of files and all credentialing functions to Joint Commission standards.
  • Prepare and accurately maintain employee personnel files to meet company and Joint Commission standards.
  • Maintained secure and confidential files in accordance to Joint Commission standards.
  • Maintain all credentialing and privileging meeting The Joint Commission standards.
  • Maintained accuracy and completeness of verifications, licensure and provider files in compliance with Joint Commission standards.

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46. Monthly Reports

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Here's how Monthly Reports is used in Credentialing Specialist jobs:
  • Generated and prepared monthly reports and maintained and updated the credentialing database.
  • Run monthly reports for missing information on physicians and radiology technicians.
  • Compile statistical data for semi-weekly and monthly reports.
  • Generated monthly reports to management department for approval.
  • Prepared and presented monthly reports to management.
  • Run monthly reports to make sure all 125+ providers' license, certificates, and DEA's are up to date.
  • Maintain database, and conduct periodic file audits, and prepare weekly and monthly reports.
  • Coordinate and prepare monthly reports and documentation for the Peer Review Committee's monthly meeting.
  • Assist with preparation and coordination of monthly reports and both off-site and on-site audits.
  • Reviewed all managed care organization fee schedules on monthly basis and conduct monthly reports.
  • Monitored monthly reports & responsible for requesting updated documents for provider's file.
  • Created monthly reports for records, closed terminated records and completed chart audits.
  • Reviewed and prepared monthly reports related to malpractice files.
  • Complied with weekly and monthly reports.
  • Update monthly reports for committee review.
  • Prepared monthly reports for airport tenants.
  • Maintain spreadsheet of employees hired and submit weekly and monthly reports of staffing activity and progress.
  • Create monthly reports to send to payers for termination, add-on, and demographic changes.
  • Conducted primary source verifications for all applicants Drafted monthly reports for executive team to track volume of contracts.
  • Generated monthly reports for Manager of Recredentialing Verified providers on NYS Inspector General website Prepared provider files for optical scanning

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47. Additional Information

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Here's how Additional Information is used in Credentialing Specialist jobs:
  • Maintain written and verbal correspondence with providers regarding status, and request for additional information to complete application process.
  • Requested additional information from physicians as necessary, upon review of all information submitted.
  • Researched and develop for additional information as needed to complete the enrollment application.
  • Requested additional information as recommended by committee members.
  • Used CAQH to obtain additional information
  • Request additional information from provider applicants or renewing providers as needed in order to determine whether they meet UMP standards.
  • Created new profiles for all providers with all of their credentials and requested additional information if needed.
  • Make calls, receive calls & email providers to answer questions or request additional information.
  • Determine if additional information is needed from the provider for the credentialing process.
  • Respond promptly to clients' requests for additional information needed for credentialing.
  • Handle all requests for additional information from insurance companies.
  • Supply any missing or additional information to plans.
  • verified provider applications, processed required information, requested additional information as needed to complete the process.
  • Communicate with healthcare professionals via phone, fax and email to clarify or request additional information.

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48. Appropriate Documentation

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Here's how Appropriate Documentation is used in Credentialing Specialist jobs:
  • Reviewed provider files for appropriate documentation required for the credentialing process for Physical, Occupational and Speech Therapists.
  • Reviewed provider files for appropriate documentation required for the credentialing process, utilizing knowledge of policies and procedures.
  • Review provider files for appropriate documentation required for the credentialing process and conduct document research as needed.
  • Review and Coordinate credentialing and re-credentialing application for appropriate documentation required for the credentialing process.
  • Facilitate ongoing re-credentialing of clinicians and ensure appropriate documentation within database management system.
  • Maintained and followed institutional polices by determining appropriate documentation of training and education.
  • Collected appropriate documentation for proper credentialing with governmental and commercial insurance participation.
  • Ensured appropriate documentation was maintained and that information was easily retrievable.
  • Reviewed provider files for appropriate documentation required for the credentialing process.
  • Maintained ongoing tracking and appropriate documentation on referrals.
  • Confirm and enter appropriate documentation on contracting modules.
  • Reviewed provider files for appropriate documentation.
  • Maintained appropriate documentation of all information.
  • Reviewed applications and verified appropriate documentation.
  • Audited new provider information and ensured complete and appropriate documentation (legal contracts and exhibits) were attached prior to processing.
  • Submit providers with all appropriate documentation to the CVO; monitor and report on progress of each providers credentialing status.
  • Review provider files for appropriate documentation required for the credentialing process Prepare files for audits and maintain electronic data input activities.

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49. Initial Applications

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Here's how Initial Applications is used in Credentialing Specialist jobs:
  • Assist with 6-month backlog of initial applications and process temporary privileges for practitioners applying to newly opened facility.
  • Processed all initial applications for Medical/Allied Health Professional Staff appointments and clinical privileges to meet policies and procedures.
  • Processed initial applications to credential medical providers for various medical practices and hospitals throughout Arizona and surrounding states.
  • Process initial applications and reappointment applications.
  • Prepared initial applications prior to submission.
  • Complete initial applications for hospital and third party insurance companies, including Medicare, Medicaid and Medi-Cal.
  • Track and ensure timely processing of Medical Staff Initial Applications and Reappointment Applications for all practice providers.
  • Completed initial applications on new physicians for NVCI and local hospitals where authorized to practice.
  • Process initial applications of Behavioral Health providers in the United Health Group network.
  • Initial Applications for all Departments and services both M.D.
  • Completed Medicare and Medicaid initial applications and reenrollments.
  • initial applications and reapplications for clients.
  • Pre-screened providers initial applications and withdrawals.
  • Examine initial applications, verify, and maintain the confidential credentials process for all physician and allied healthcare professional applicants.
  • Initial applications and reappointments for a variety of hospitals across the state of New Jersey.
  • Process initial applications to comply with the Joint Commission on Accreditation of Healthcare Organizations.
  • Complete and submit all initial applications for new providers, (M.D.
  • Close initial applications within a 60 day timeframe.
  • Reviewed initial applications for criteria requirements Initiated verification process Prepared completed applications for committee review and approval
  • Credentialed assigned Radiologists using eVIPS credentialing software Completed reappointment and initial applications

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50. New Physicians

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Here's how New Physicians is used in Credentialing Specialist jobs:
  • Provided information and assistance at new physicians' orientation meetings.
  • Complete all managed care and commercial payer applications for new physicians hired for 3 companies within ARPG.
  • Enter all new physicians into the credentialing database, maintain updated information on all current providers.
  • Add all new physicians' information to the data base, education, privileges etc.
  • Completed credentialing documentation for new physicians, nurses and PA s when joining insurance companies.
  • Process all paper work and enrollments for new physicians joining the practice.
  • Enrolled new physicians with 18 group practices in 13 insurance plans.
  • Prepare enrollment packages for new physicians on an ongoing basis.
  • Prepared credentials files for new Physicians and follow-up as required.
  • Credentialed all new physicians with 15 different Insurance Carriers.
  • Handled other insurance enrollment forms for new physicians.
  • Manage health plan enrollment of new physicians.
  • Credentialed new physicians with all insurance companies.
  • Obtained required credentials for new physicians.
  • Added new physicians to insurance contracts.
  • Obtain hospital and insurance credentials for new physicians/staff and coordinate reappointments.
  • Provided guidance to all new physicians in their efforts to obtain all necessary licensure to work in the State of Nevada.
  • Updated all information with CAQH quarterly, Revalidation and added new Physicians, PA's and NP's to Medicare-PECOS.
  • Enter new physicians in the Meditech and Health Line systems.
  • Coordinate the credentialing process for new Physicians assigned to two (2) Kaiser Permanente hospitals and several clinics .

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3 New Physicians Jobs

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20 Most Common Skills For A Credentialing Specialist

Providers

31.6%

Credential Files

12.7%

Medical Staff

5.6%

Medical Malpractice

4.7%

DEA

4.5%

Primary Source Verification

4.2%

Ncqa

3.8%

Insurance Companies

3.6%

Hospital Privileges

3.4%

Caqh

3.3%

Health Care

3.1%

Medicare

2.8%

Medicaid

2.8%

Data Entry

2.7%

Board Certification

2.3%

Customer Service

2.0%

Ensure Compliance

2.0%

Health Professionals

1.9%

Npdb

1.5%

Background Checks

1.3%
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Typical Skill-Sets Required For A Credentialing Specialist

Rank Skill
1 Providers 25.3%
2 Credential Files 10.2%
3 Medical Staff 4.5%
4 Medical Malpractice 3.8%
5 DEA 3.6%
6 Primary Source Verification 3.4%
7 Ncqa 3.1%
8 Insurance Companies 2.9%
9 Hospital Privileges 2.7%
10 Caqh 2.7%
11 Health Care 2.5%
12 Medicare 2.3%
13 Medicaid 2.3%
14 Data Entry 2.2%
15 Board Certification 1.9%
16 Customer Service 1.6%
17 Ensure Compliance 1.6%
18 Health Professionals 1.5%
19 Npdb 1.2%
20 Background Checks 1.1%
21 Medical Licenses 1.1%
22 Committee Meetings 1.1%
23 Provider Applications 1.1%
24 CMS 1.1%
25 Current State Licenses 1.0%
26 Jcaho 0.9%
27 OIG 0.8%
28 Medical Staff Bylaws 0.8%
29 NPI 0.8%
30 Reappointment Applications 0.8%
31 Special Projects 0.7%
32 Committee Review 0.7%
33 Practitioner Data 0.7%
34 Hipaa 0.6%
35 Office Staff 0.6%
36 Malpractice Coverage 0.6%
37 Phone Calls 0.6%
38 CME 0.6%
39 Nurse Practitioners 0.6%
40 Accurate Data 0.5%
41 Ensure Accuracy 0.5%
42 Medical Records 0.5%
43 Physician Assistants 0.5%
44 External Customers 0.5%
45 Commission Standards 0.4%
46 Monthly Reports 0.4%
47 Additional Information 0.4%
48 Appropriate Documentation 0.4%
49 Initial Applications 0.4%
50 New Physicians 0.4%
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