Mindlance
Summary: The Credentialing Specialist is responsible for credentialing individual, facility and/or ancillary medical/surgical providers to ensure all credentialing standards and internal requirements are met and maintained.Job Responsibilities: Verifies and maintains all network, individual and/or facility/ancillary providers' information. Monitors disciplinary actions, and follows up accordingly. Corresponds with licensing board, hospitals, certification agencies, training programs and medical groups to resolve any issues. Ensures and maintains overall accuracy of credentialing database. Gathers data, builds/runs reports, and sends out updates. Corresponds with licensing board, hospitals, certification agencies, training programs and medical groups, practitioners, office staff, provider network administrators, contracting and management to resolve issues. May review and identify credentialing or re-credentialing practitioners, including verifications of correspondence, data entry, etc., in accordance with company policies and procedures. Reviews and analyzes reports, policies and procedures, summarizes, analyzes and makes notations in reports for feedback to groups and for distribution to management and Credentialing Committee. Assists in the preparation of file reports and binders for monthly Credentialing Committee meetings, including pre-and post-Committee functions. Assists on internal projects to obtain follow-up information as requested by Credentialing Committee or Peer Review Teams. Performs other duties as assigned.Education/Experience: High school diploma. Associate's degree in Business Administration, Health Care Administration or related field preferred.0-2 years of experience
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
"Position Purpose: Perform credentialing and related activities based on plan specifications
Education/Experience: Associate's degree, or high school diploma/equivalent and 1+ years of data entry, customer service, medical office, provider data management, credentialing or healthcare operations (i.e. claims processing, billing, provider relations or contracting) experience, preferably in a managed care or insurance environment." "• Perform credentialing and re-credentialing activities according to plan specifications and in compliance with NCQA standards • Communicate with professionalism with physicians, office managers, providers, and other third parties to secure needed information • Gather information for Credentialing Committee meetings • Process, track and file credentialing applications within established standards • Generate and utilize reporting to support business functions • Ability to thrive in a fast-paced production environment while maintaining quality" Story Behind the Need - Business Group & Key Projects Health plan or business unit Team culture Surrounding team & key projects Purpose of this team Reason for the request Motivators for this need ny additional upcoming hiring needs? We process requests from existing, already contracted groups for the entire state of Florida who are interested in adding new practitioners that have joined their group. The Credentialing Specialist will be part of the Credentialing Triage team. The candidate will be responsible for vetting the online requests received from existing providers, gathering the required credentialing documents and submitting the request through our internal system. If missing information is identified, the specialist will be reaching out to our providers via email to request any missing information. The team currently consists of 11 credentialers, processing requests for all lines of business. One manager, and one supervisor. Time management is crucial because if they request missing information, once the information is received, they will be required to complete the process in a timely manner, while working on the new requests we receive in the mailbox from providers and through our system from internal customers. Credentialing knowledge is helpful but not required, Excel, attention to detail, organizational skills, the ability to prioritize & pivot, communicational skills, problem solving and work under pressure.
Typical Day in the Role
Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description The online webform submissions generate an email that is received in a shared mailbox. Each credentialer has a folder with their name on it and the emails are assigned to those folders. We have a team chat for anyone on the team to ask questions. The idea is for the emails assigned to be worked from oldest to newest, they will create a practitioner folder in our S Drive where all the documents will be gathered and saved. If they can complete the process, the request is submitted through our internal system and a communication to the provider is sent letting them know the process was completed. Missing information is tracked in our SharePoint. During the training/learning process the opportunity for OT will not be available. Once the employee can meet our required metrics of completing 75 requests a week during their 8hr shift, and is able to work independently, the OT opportunity will be extended. Daily schedule is 8:00am - 4:30pm. which can be flexible during the day.
Compelling Story & Candidate Value Proposition
What makes this role interesting? Points about team culture Competitive market comparison Unique selling points Value added or experience gained What makes this role interesting is that not all the requests are the same. We receive requests from groups for different specialties. Our current influx of requests are from Behavioral Health groups. Our key initiative is to become and remain current with the practitioner add requests we receive via the practitioner adds mailbox. Getting the new providers added to the network in a timely manner to prevent member impact. We have a 45-day turnaround time we must achieve and maintain manner to prevent member impact, AHCA complaints or provider abrasion. Our team is in queue to start being audited this year and a consecutive quality score of 95% will be required to start. This expected score will go up to 99% once the team gets acclimated to the auditing process.
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
"Position Purpose: Perform credentialing and related activities based on plan specifications
Education/Experience: Associate's degree, or high school diploma/equivalent and 1+ years of data entry, customer service, medical office, provider data management, credentialing or healthcare operations (i.e. claims processing, billing, provider relations or contracting) experience, preferably in a managed care or insurance environment." "• Perform credentialing and re-credentialing activities according to plan specifications and in compliance with NCQA standards • Communicate with professionalism with physicians, office managers, providers, and other third parties to secure needed information • Gather information for Credentialing Committee meetings • Process, track and file credentialing applications within established standards • Generate and utilize reporting to support business functions • Ability to thrive in a fast-paced production environment while maintaining quality" Story Behind the Need - Business Group & Key Projects Health plan or business unit Team culture Surrounding team & key projects Purpose of this team Reason for the request Motivators for this need ny additional upcoming hiring needs? We process requests from existing, already contracted groups for the entire state of Florida who are interested in adding new practitioners that have joined their group. The Credentialing Specialist will be part of the Credentialing Triage team. The candidate will be responsible for vetting the online requests received from existing providers, gathering the required credentialing documents and submitting the request through our internal system. If missing information is identified, the specialist will be reaching out to our providers via email to request any missing information. The team currently consists of 11 credentialers, processing requests for all lines of business. One manager, and one supervisor. Time management is crucial because if they request missing information, once the information is received, they will be required to complete the process in a timely manner, while working on the new requests we receive in the mailbox from providers and through our system from internal customers. Credentialing knowledge is helpful but not required, Excel, attention to detail, organizational skills, the ability to prioritize & pivot, communicational skills, problem solving and work under pressure.
Typical Day in the Role
Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description The online webform submissions generate an email that is received in a shared mailbox. Each credentialer has a folder with their name on it and the emails are assigned to those folders. We have a team chat for anyone on the team to ask questions. The idea is for the emails assigned to be worked from oldest to newest, they will create a practitioner folder in our S Drive where all the documents will be gathered and saved. If they can complete the process, the request is submitted through our internal system and a communication to the provider is sent letting them know the process was completed. Missing information is tracked in our SharePoint. During the training/learning process the opportunity for OT will not be available. Once the employee can meet our required metrics of completing 75 requests a week during their 8hr shift, and is able to work independently, the OT opportunity will be extended. Daily schedule is 8:00am - 4:30pm. which can be flexible during the day.
Compelling Story & Candidate Value Proposition
What makes this role interesting? Points about team culture Competitive market comparison Unique selling points Value added or experience gained What makes this role interesting is that not all the requests are the same. We receive requests from groups for different specialties. Our current influx of requests are from Behavioral Health groups. Our key initiative is to become and remain current with the practitioner add requests we receive via the practitioner adds mailbox. Getting the new providers added to the network in a timely manner to prevent member impact. We have a 45-day turnaround time we must achieve and maintain manner to prevent member impact, AHCA complaints or provider abrasion. Our team is in queue to start being audited this year and a consecutive quality score of 95% will be required to start. This expected score will go up to 99% once the team gets acclimated to the auditing process.