Credentialing ProcessorPrimary Location: Plantation, Florida
Additional Locations: FL-Plantation Apply
- Reviews (re)credentialing data for completeness, accuracy and conducts research pertaining to missing data.
- Performs accurate and timely baseline demographic transaction updates in provider/producer system applications.
- Analyzes data to identify variances in information furnished by providers/producers against primary verification sources.
- Utilizes systems to maintain credential files, EPC and CARDS to track queries, documentation of phone calls, correspondence, completed applications, and outcomes.
- Contacts providers/producers to clarify and resolve data quality issues. Identifies potential risk situations, collects pertinent information and completes investigation.
- Reports results of credentials findings and document further action needed.Protects the confidentiality and integrity of provider/producer data files.
- Conducts and manages ongoing review of provider/producer compliance to contract requirements.
- Researches, investigates, approves and coordinates resolution of business exceptions with internal and external constituents. Identifies and appropriately escalates data transaction and credentialing issues that might potentially have significant adverse impact on service levels.
- Monitors and reports data elements for quality against standards.
- Manages incoming requests for provider/producer application and status requests, utilizing systems to determine eligibility for network participation.
- Performs recredentialing application management process for all outstanding applications at risk of non-compliance. Utilizes data systems to access information to respond to customer service call line questions maintaining service call TAT, ASA and high quality customer satisfaction goals.
- College degree or equivalent work experience preferred
- High School Diploma or G.E.D.
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