Executive[Credentialing] | Credence Global Solutions

Accounts Receivable Executive is responsible for all aspects of credentialing and re-credentialing of health care professionals. This position ensures all health care professionals are appropriately credentialed, which includes the responsibility of maintaining current information on file and within the credentialing database & Fee schedule Negotiation.

This position primarily works independently, but frequently coordinates with other team members, Credentialing Manager and Medical Director.

• Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on NCQA standards, health plan requirements and company credentialing policies.
• Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
• Prepare and scan credentialing/re-credentialing files and other credentialing documentation into scanning software.
• Data entry of new applications in the credentialing database.
• Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing.
• Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes.
• Answer credentialing telephone line and provide support to physicians, physician office staff, health plan contacts and company departments as necessary.
• Process provider network terminations, specialty/category changes, leave of absence requests.
• Cross train within department to support credentialing operations (providing back-up support for telephones, credentialing files, vacation/PTO).
• Perform other related duties as assigned by management.
• Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies.
• Always maintain privacy and confidentiality.
• Maintain CAQH (Council for Affordable Quality Health Care) database and application process.
• Maintain the credentialing database and ensure up-to-date information is always obtained.

Candidate Requirements

• Must demonstrate exceptional communication skills, listening effectively and asking questions when clarification is needed.
• Ability to follow instructions and respond to Managements directions accurately.
• Demonstrates accuracy, organizational and problem-solving skills. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Maintain confidentiality.
• Work independently, prioritize work activities and use time efficiently.
• Must demonstrate and promote a positive team-oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must possess ability to manage change, delays, or unexpected events appropriately.
• Minimum 3 Years or Experience in US Health Care.
• Experience with CAQH (Council for Affordable Quality Health Care) database and application process.

Skills Required
Database Management, credentialing