Credentialing Specialist

Credentialing Specialist Paramount Health Options Cedar Rapids, IA Job Details Full-time $18 - $22 an hour 1 day ago Benefits Disability insurance Dental insurance 401(k) Paid time off Flexible schedule Qualifications Teamwork Writing skills Customer inquiry handling High school diploma or GED Attention to detail Data entry Productivity software Time management Full Job Description Are you looking for a new career? Do you enjoy doing a variety of tasks in a fast-paced work environment? Paramount Health Options is experiencing unprecedented growth and is hiring. Paramount Health Options (PHO), formerly Cedar Rapids Physician Hospital Organization, is a provider-owned, member-driven partnership formed in 1994. PHO works with physicians, allied health professionals and hospitals across Iowa, Illinois, Minnesota, Nebraska and South Dakota. Key services offered by PHO include payer contracting, payer credentialing and enrollment, re-credentialing, hospital privileging, Medicare and Medicaid enrollment, ongoing monitoring, primary source verification, claims resolution, group purchasing, education seminars and office resources. The Credentialing Specialist is responsible for processing provider and facility applications, working with medical offices and providers to gather information, processing the information in specialized database, notifying payers of network additions, notifying facility privileging clients of provider file status, and other credentialing duties as assigned. Skills and Requirements

• High school diploma required, college degree preferred;
• 1 year related experience;
• Experience working with physicians, hospitals and insurance carriers preferred;
• Detail-oriented;
• Ability to work as a team member and independently;
• Strong knowledge of Microsoft Office;
• Excellent written and verbal communication skills;
• Ability to complete tasks in a timely and accurate manner;
• Excellent organizational and time management skills;
• Ability to work effectively as a team and independently with little direction;
• Able to handle various projects simultaneously and prioritize effectively to meet deadlines;
• Exceptional customer service skills;
• Ability to keep a positive attitude in difficult situations;
• Ability to maintain confidentiality.

Job Responsibilities:

• Maintain proficient knowledge PHO Credentialing Policies and Procedures which encompass CMS, URAC and NCQA guidelines, maintain compliance with guidelines, and recommend revisions when needed;
• Accurate data entry and/or verification of data entry of the provider or facility application, licensure, and other required information to the credentialing database;
• Confirm all required verifications are complete and have been performed according to required standards and within required timeframes;
• Summarize provider information for peer review by the Credentialing Committee;
• Prepare files for annual audits by payers to be reviewed by Credentialing Coordinator and/or Director of Operations;
• Perform second review of internal audits on credentialing and re-credentialing files for ongoing monitoring of accuracy;
• Answer inquiries regarding provider and facility credentialing status. Research and problem solve internal and external inquiries;
• Work with external and internal customers to ensure timeliness and accuracy of all files;
• Produce provider correspondence as necessary to process the applications;
• Maintain required logs and prepare reports, as needed;
• Keep manager informed of concerns or problems with credentialing processes;
• Identify and implement workflow efficiencies as appropriate;
• Communicate verbally and in writing with internal and external customers;
• Contribute to team effort by accomplishing related tasks as needed;
• Process Medicare and Medicaid provider and facility enrollment, changes and terminations;
• Cooperates with operations to assure Company retains NCQA certification;
• Maintain high levels of integrity and uphold ethical standards;
• Conduct all interactions with internal customers with a high level of respect and gentleness in an approachable manner to promote a collaborative working environment;
• Other duties as assigned.

This is a full-time position, with day-time flexible hours Monday through Friday. Paramount Health Options offers a competitive benefit package including health, dental, life and disability insurance, health spending accounts, identity theft protection, paid time off, and a 401k retirement plan.

Job Type:

Full-time Pay:

$18.00 - $22.00 per hour

Work Location:

In person