Provider Data Services Rep – 6 Month Assignment Position Available In Duval, Florida
Tallo's Job Summary: This Provider Data Services Rep - 6 Month Assignment position involves administering credentialing and recredentialing activities for physicians/providers in Networks, ensuring compliance with regulatory agencies. Responsibilities include data research, verification, analysis, and streamlining credentialing processes. Requirements include a high school diploma, 3 years of healthcare experience, and familiarity with regulatory requirements. Hiring is open to all qualified candidates.
Job Description
Job Description:
This position exists to ensure accurate and timelyadministration of the credentialing and recredentialing activitythat takes place for physician/providers in our Networks. Theindividuals in this role perform the critical core businessactivities associated with ensuring that we are in compliance withregulatory and licensing agencies (NCQA, CMS, ACHA). The workperformed by these individuals include the accumulation andresearch of specified documents, databases, Internet websites, etcfor the purpose of credentialing potential and existing providers.
Representative duties include, but are not limited to, thefollowing: Ensure that BCBSFL maintains a broad network ofqualified providers through credentialing and recredentialingprocesses: ? Accumulate and research specified documents,databases, Internet websites, etc. for the purpose of credentialingpotential and existing providers. (including CVO vendor) ? Ensurecompliance with various regulatory and licensing agencies. ?Perform accurate and timely provider data research, collection,verification and analysis. ? Compile provider data from variouslegal documents, compliance websites and monitoring agencies tosupport decisions for network participation. ? Analyze providerdata and translate complex court documents and legal proceedingsfor discussion with Medical Consultants. ? Utilize continuousprocess improvements to streamline credentialing cycle time. ?Extract data from PIP (Provider Information Platform) to createcommunication for provider notification. ? Independently plan,organize and perform on-going inventory reduction strategies basedon changing deadline
Job Requirements:
Required:
? High school diploma or equivalent ? 3years healthcare related experience ? Experience with regulatoryagency requirements (NCQA, CMS, DEA, etc) ?
MS Word Preferred:
?Credentialing experience including website research ? Experiencewith PIP ? Experience with Client Letter ? Experience with providerdemographic file maintenance ? Experience with contractingprocesses We are an equal employment opportunity employer and will considerall qualified candidates without regard to disability or protectedveteran status.
