PLEASE DO NOT APPLY IF YOU DO NOT HAVE US HEALTHCARE CREDENTIALING EXPERIENCE
OMC is looking for a Delegated Credentialing Supervisor (Remote) to join our team! The Delegated Credentialing Specialist is responsible for organizing, maintaining, and verifying all aspects of the delegated credentialing process for General, Urgent care and Surgeons. In all activities, they must comply with all legal and regulatory policies and procedures. Minimum 3-5 years’ experience in Healthcare Credentialing required. This role will be to take on existing clients, get information uploaded to new credentialing software with a plan to expand sales for credentialing and subsequently expand the credentialing team under the guidance of the Supervisor.
Responsibilities:
1. Adhere to NCQA guidelines.
2. Audit Provider Licensure Files to NCQA guidelines.
3. Pull On-Going Files in accordance to NCQA.
4. Understanding of Initial and Re-Credential Delegated files.
5. Delegated Credentialing Payer Submissions.
6. Prepare and distribute facility and provider applications to payers.
7. Coordinate, monitor and maintain all credentialing and re-credentialing processes.
8. Upload and update the system with new documents.
9.
Ongoing interaction with payers.
10. Assist offices and internal departments with credentialing issues.
11. Must be able to utilize the licensure portals.
12. Source for effective dates from the payers.
13. Notify relevant parties of effective dates.
14. Keep records in licenses, credentials and insurance contracts.