• Support team in obtaining and validating documents for personnel files
• Order Pre-employment services such as drug screens, health services, backgrounds, certification courses, etc.
• Complete verifications of education, licensure, employment
• Maintain credentialing documents in an internal database, including updating expiring traveler items
• Establishes strong relationships and displays excellent customer service skills
• Enter data and attestations into CAQH.
• Maintain CAQH spreadsheet, including license and liability expirations to ensure timely renewal.
• Enter credentialing data in the billing system.
• Complete Provider Applications And Other Credentialing Requirements
• Maintain documentation required for credentialing and attestation.
• Ensure practice addresses are current with health plans, agencies, or other entities.
• Routine communication and follow-up with clinical staff and commercial carriers.

Skills: Credentialing Documentation Management, Pre-Employment Services Coordination, Data Entry Proficiency, Credential Verification, Customer Service Excellence, CAQH Data Management, Effective Communication, Detail-Oriented

• Primary responsibilities include taking a new provider application from receipt to inclusion on the directory for providers that have applied to the network.
• Maintains confidential files of Provider records to meet NCQA and delegated standards.
• Keeps abreast of NCQA guidelines and other regulatory and legal requirements alerting management of any known changes.
• Pulling provider files (applications with/ supporting documents for processing) from CVO portals and from internal email boxes.
• Communicate with Providers / Practice Managers to initiate, update, and maintain credentialing records.
• Enter and maintain Provider applications and information into the cred system
• Verify current and existing Provider's licensure, NPI, liability insurance, CDS and DEA certification
• Verify the Provider's education, hospital privileges, Board certification and other criteria
• Verify the Provider’s sanction monitoring via OIG, SAM, and OFAC verifications.
• Perform ongoing research to correct data to prevent duplicate entry of provider demographics.
• Utilize various systems and websites to ensure accuracy.

Skills: Provider Application Management, Confidential Record Maintenance, Regulatory Compliance Awareness, File Retrieval and Processing, Provider Communication, Credentialing Data Entry, Verification of Credentials, Sanction Monitoring and Data Accuracy

• Responsible for the completion and submission of all compliance documentation for all registrants.
• Order name badges for new hires.
• Responsible for onboarding of external applicants.
• Assists employees to ensure personal information in the applicant tracking system is accurate and current.
• Ensure compliance with all federal, state, and local laws and regulations related to all business practices.
• Track credentialing activities through various reports.
• Maintain relationships with clients and external employees by providing excellent customer service.
• Maintains credentialing files and keeps up with expiring credentials.
• Assists other team members to meet the need of ISA’s goals.
• Follow all safety rules and regulations as well as housekeeping policy to ensure an orderly and safe working environment.

Skills: Compliance Documentation Management, Onboarding Coordination, Applicant Tracking System Maintenance, Regulatory Compliance, Credentialing Activity Tracking, Client and Employee Relationship Management, Credentialing File Maintenance, Safety and Housekeeping Adherence

• Verify and maintain Proctor and Exam-Candidate information for ISA’s Exam Manager program.
• Ensure all necessary licenses and credentials are verified for eligibility including reviewing and tracking Exam-Candidate applications.
• Assist with the new-hire process by reviewing information contained within job applications and resumes to ensure that applicants meet all credential requirements for the arboriculture industry relating to the specific position of interest.
• Ensures services are in compliance with ANSI state and federal regulations.
• Maintain database platforms and audit logs to track licensing for compliance with ANSI federal standards.
• Contributes to a safe and secure Credentialing Vault environment by participating in all training and refresher courses to ensure the security of exams and related materials.
• Control and secure access to authorized staff for the Credentialing Vault area.
• Ensures that all materials are stored in locked cabinets to maintain restrictions to confidential exam materials.
• Compile and submit routine reports for Credentialing supply materials.
• Maintains confidentiality of information to prevent exposure during the course of business operations regarding Proctors,

Skills: Proctor Information Management, Credential Verification, New-Hire Credential Review, Regulatory Compliance, Database and Audit Log Management, Credentialing Vault Security, Access Control, Confidential Material Storage

• Adhere to organizational and departmental policies and procedures.
• Utilize appropriate customer relations skills when interacting with customers, team members, and visitors to ensure all are treated with respect and dignity.
• Prepare and submit credentialing and re-credentialing applications for all clinical providers, including doctors and nurses 
• Communicate with clinical providers via phone and email 
• Assist clinical providers with completing necessary forms and collecting documentation 
• Maintain consistent contact with providers to ensure that expectations are clear and requirements are completed in a timely manner 
• Maintains copies of current credentialing documents for all providers 
• Communicate with medical malpractice insurance agencies and payers via phone and email 
• Keep careful documentation of each clinician and where they are in the credentialing cycle
• Review billing to ensure meeting payer requirements and assist in the quality assurance review process.

Skills: Policy Adherence, Customer Relations, Credentialing Application Management, Provider Communication, Form Assistance, Timely Provider Follow-Up, Document Maintenance, Insurance and Billing Coordination

• Maintain credentialing information by reviewing, entering, and following up on missing information
• Update the system and the credentialing database to reflect approvals, denials and/or terminations.
• Meet required turnaround times and accuracy rates
• Partnering with management to prioritize workflow volume.
• Assists co-workers for effective/efficient operation of department.
• Actively promote process improvement techniques in all work assignments and with special projects
• Contact providers and assist them through the credentialing process with both commercial and Medicaid Networks, following up on missing documents to ensure completion of credentialing process.
• Monitor Staff credentials and Licensure.
• Prepare and submit credentialing applications and supporting documentation for the purpose of enrolling providers with commercial and Medicaid Networks.
• Follow up on the status of applications for providers and payers, tracking progress on all pending and completed work.
• Submit EFT and ERA applications ensuring electronic payments are received from payers.

Skills: Credentialing Information Management, System and Database Updates, Accuracy and Turnaround, Workflow Prioritization, Co-Worker Support, Process Improvement, Provider Credentialing Assistance, Application and Payment Processing

• Perform the administrative and technical duties necessary to complete the provider enrollment process.
• Work directly with administrative contacts and customers which including performing regular updates and communicating clearly on the status of the enrollment process to customers and contacts as designated by the customer, or manager regularly.
• Provide superior customer service at all times to internal and external contacts including customers, providers, representatives, and other staff.
• Manage the onboarding process by working directly with providers to help facilitate the process of PSV and enrollment with insurance payers.
• Manage the credentialing process from start to finish including obtaining applications from the payers
• Completing applications accurately, submitting applications timely per policy or within a reasonable time frame to avoid delays, completing regular follow-ups with the payers to ensure applications are being processed, and obtaining contracts once the credentialing process is completed.
• Properly maintain files on each provider by the customer, items may include (CAQH, CV, certifications, licenses, malpractice files, hospital privileges, etc.)
• Maintain accurate and proper records in the credentialing database
• Work closely with the other team members to ensure that the enrollment is handled as quickly and professionally as possible
• Assist team in updating credentialing database

Skills: Provider Enrollment Management, Customer Communication, Superior Customer Service, Onboarding Process Management, Credentialing Process Oversight, File Maintenance, Database Record Accuracy, Team Collaboration

• Input data per project requirements
• Upload documents into database storage
• Coordinates with providers or representatives to obtain biographical information, including state and federal licensing and certifications, educational background, prior professional experience, hospital affiliations and all additional documents related to credentialing and re-credentialing.
• Processes all requests for credentialing and re-credentialing from start to finish of entire credentialing process within established and expected timelines.
• Responsible for maintaining a follow up log regarding the status of outstanding applications.
• Establishes relationships with delegated credentialing entities’ staff to permit the flow of communication and transfer of credentialing information as appropriate.
• Maintains all provider credentialing files in accordance with all Department of Health (DOH) and accrediting organizations (AO) and updates the provider grid
• Respond to various inquiries from providers, staff, hospitals and healthcare organizations timely and with professionalism.
• Serves as the subject-matter expert for medical staff credentialing requirements during any on-site inspection or survey.
• Facilitates internal project meetings

Skills: Data Entry, Document Upload, Credentialing Coordination, Credentialing Process Management, Follow-Up Tracking, Relationship Building, File Maintenance, Inquiry Response

• Manage credentialing process for New Story providers to ensure compliance with governmental and commercial payors.
• Obtain all needed documentation from providers, such as copies of state licenses, board certifications, NPI, and any other pertinent information.
• Accurately complete credentialing and reappointment applications to be sent to payers and facilities on behalf of the providers.
• Serve as a liaison for onboarding new providers for New Story.
• Maintain MODIO/OneView credentialing database, to include all providers, electronic storage of documents needed for credentialing, and documentation of all communication relating to the credentialing process.
• Submit applications for new payer contracts.
• Responsible for providing exceptional internal (care centers, RCM, Finance, etc.) and external (payors, regulatory agencies, etc.) customer service.
• Responsible for the submission and maintenance of provider credentialing with the payer.
• Responsible for CMS-required Attestation/Verification (Availity, Lexis Nexus, etc.).
• Responsible for Roster Reconciliation and Roster Submission

Skills: Credentialing Process Management, Documentation Collection, Application Completion, Provider Onboarding, Database Maintenance, Payer Contract Applications, Customer Service, Credentialing Submission and Attestation

• Accurately documents all interactions related to contracting and credentialing, with employees and payers, in the credentialing database.
• Accurate and timely follow-up of all needed documentation and applications.
• Possess and maintain a high level of integrity in handling sensitive and confidential information.
• Completes prompt follow-up to all interactions and requests for information, both internally and externally.
• Understand the Revenue Cycle Management process and the integral role of Credentialing in that process.
• Professionally interacts with providers, New Story associates, and payors to resolve questions and concerns and presents a positive and professional image at all times.
• Monitors and adheres to applicable Federal, State, and local laws and regulations, New Story’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures.
• Knows, understands, incorporates, and demonstrates the New Story Mission, Vision, and Values in behaviors, practices, and decisions.
• Communicate with multiple departments (Clinics, Billing, Collections) regarding provider status with health plan enrollment
• Audit reports based on information input into database software to ensure accurate information reporting out to various departments

Skills: Interaction Documentation, Timely Follow-Up, Confidentiality, Prompt Communication, Revenue Cycle Management Understanding, Professional Interaction, Regulatory Compliance, Departmental Communication and Auditing

• Ability to develop and demonstrate superb multi-tasking skills to effectively accomplish multiple required and competing tasks.
• Ability to maintain minimal phone and computer handling skills.
• Ability to communicate clearly and concisely across multiple levels within the company.
• Ability to maintain the confidentiality of all provider information and company documents.
• High-level experience in using HireRight Systems would be desirable
• Entry level for more complex support and administrative functions.
• Ability to apply generally straightforward methods or procedures.
• Good knowledge, experience, and skill in standardized rules, procedures, or operations on a variety of activities requiring training
• Ability to maintain confidentiality of providers' information.
• Ability to accurately enter relevant information into the credentialing system and other ancillary data repositories
• Knowledge of healthcare industry issues

Qualifications: BA in Health Administration with 6 years of Experience

• Experience in the field of credentialing/MSO (preferably healthcare-related)
• Strong Computer database skills and word processing. 
• Proficient use of Microsoft Office applications (Word and Excel), and Internet resources.
• Experience using Provider Credentialing software systems or Provider Data Management systems
• Ability to organize and prioritize workload and manage multiple priorities to meet strict deadlines.
• Excellent verbal and written communication skills including letters, and emails.
• Proficient and accurate in data entry.
• Strong organizational skills.
• Ability to work in a fast-paced environment.
• Strong problem-solving skills and attention to detail.
• Strong personal motivation with the ability to work with little supervision and attention to detail while working in a deadline-driven environment.

Qualifications: BS in Healthcare Management with 4 years of Experience

• Experience in delegated and/or non-delegated medical groups, hospitals, or clinic environments.
• Experience in Health Care Authority registration regulations and Provider One system.
• Experience in One Health Port/Provider Source and CAQH registration regulations.
• Demonstrated ability to manage multiple priorities and competing deadlines.
• Solid computer skills, with proven knowledge of database maintenance, Excel and Word.
• Ability to possess a certified Provider Credentialing Specialist (CPCS)
• Knowledge of Health systems and administrative functions, including phones, files, reports, correspondence, presentations, etc.
• Ability to develop and maintain strong professional relationships with team members at all levels with varying educational, ethnic, professional and economic backgrounds.
• Able to navigate and prioritize tasks and proficiently organize and manage timelines. 
• Strong administrative, office, and organizational skills, with attention to detail and ability to manage time and priorities.

Qualifications: BA in Business Administration with 5 years of Experience

• Proven ability to develop process improvements based on known errors or identified risks
• Excellent verbal and written communication and personal interaction skills, with an emphasis on customer service and support.
• Proficiency with MAC applications, and Google Drive applications
• Experience with electronic recording keeping and credentialing software.
• Knowledge of HIPAA requirements that pertain to client information and client privacy.
• Ability to work effectively with minimal supervision, manage multiple duties and priorities, and maintain high standards for accuracy, productivity, and confidentiality.
• Flexibility, with the ability to work effectively with a number of supporting teams.
• Ability to effectively present information and respond to questions from managers, clients, customers, and the general public.
• Ability to think creatively, highly driven, self-motivated, highly organized
• Ability to create and deliver presentations to clients, staff and others
• Ability to maintain confidentiality in business interactions for improper disclosure would be contrary to professional ethics and would likely cause serious organizational conflict.

Qualifications: BS in Public Health with 4 years of Experience

• Understands provider enrollment
• Understanding of the credentialing and privileging processes for hospitals and ambulatory care settings
• Computer Proficiency, Microsoft Office to include Word, Excel, PowerPoint
• Ability to work with multiple application-specific databases
• Excellent interpersonal skills and customer service orientation
• Ability to work within and promote a team environment
• Ability to work with multiple projects and deadlines and to support medical staff leaders and functions.
• Strong analytical skills
• Excellent written and verbal communication skills and organizational ability
• Possesses strong management skills
• Knowledge of HIPAA, HITECH and other rules and regulations in the healthcare industry
• Ability to thrive in a fast-paced, dynamic organization

Qualifications: BA in Human Resources Management with 3 years of Experience

• Ability to follow standard operating procedures of P3 Health Partners as provided.
• Ability to follow routine credentialing procedures and processes consistently and efficiently.
• Excellent verbal and written communication skills.
• Ability to work independently and in conjunction with all team members at all levels of the organization. 
• High level of interpersonal skills to handle sensitive and confidential situations.
• Highly organized, detail-orientated individual with multi-tasking abilities.
• Able to work in a fast-paced environment with demonstrated ability to juggle multiple competing tasks and demands
• Self-motivated individual who is adaptable to change.
• Proficient in Microsoft Outlook, Excel and Word.
• Ability to gather all necessary licensure and other Practitioner background items.

Qualifications: BS in Nursing with 2 years of Experience

• Ability to enter, maintain and update the credentialing system used by P3 Health Partners.
• Ability to enter, maintain and update Practitioner credentialing data storage files.
• Ability to process credentialing applications to contracted insurances/networks including Medicare and Medicaid on behalf of all group Practitioners including initial and credentialing
• Ability to process credentialing applications to Hospitals/SNFs/Surgery Centers, etc on behalf of all group Practitioners including initial and credentialing 
• Ability to enter, maintain and update the Practitioner's CAQH credentialing information using online system.
• Ability to Perform primary and secondary source verification of Practitioner's credentials according to P3 Health Partners policies.
• Ability to provide updates to appropriate outside credentialing contacts/databases/websites as necessary to ensure Practitioner information is current and accurate.
• Knowledge of policy and procedure development. 
• Strong Computer skills including word processing, spreadsheets, and database applications 
• Ability to tactfully interact with medical practitioners, staff and handle a variety of situations 
• Excellent organizational and communication skills

Qualifications: BA in Medical Office Administration with 4 years of Experience

• Ability to Prepare clinician applications, including supporting documentation, to applications and maintain information databases for qualified providers/consultants.
• Ability to Coordinate internally with providers to obtain new and updated documentation required for credentialing and re-credentialing.
• Ability to Implement policies, procedures and processes to ensure timely and efficient credentialing/credentialing.
• Ability to Submit completed credentialing payor applications for providers/consultants and track the length of time for credentialing and re-credentialing processes.
• Ability to Follow up with insurance companies weekly to track the enrollment progress of providers/consultants and document conversations.
• Ability to Maintain provider/consultant rosters for payors' weekly/monthly submissions and contractual requests.
• Experience in managing multiple projects and requests from the Manager of Credentialing.
• Ability to meet deadlines and communicate updates regularly with the Manager of Credentialing and internal clients.
• Ability to record and log all data in credentialing software in order to review daily performance, 
• Ability to ensure compliance and identify conflicts or changes requiring resolution from the Manager of Credentialing.

Qualifications: BS in Health Information Management with 5 years of Experience

• Ability to analyze situations, identify problems, and recommend solutions to the Manager of Credentialing.
• Ability to answer emails, maintain contact lists, and be a point of contact for internal and external clients.
• Ability to prepare reports, memos, and documents and sort incoming mail, faxes, and courier deliveries for distribution.
• Excellent verbal and written communication skills
• Ability to compile, interpret and utilize information, and to communicate effectively with people of all demographics and education levels.
• Ability to work with minimal supervision, use good judgment, meet deadlines and prioritize workloads.
• Ability to maintain confidentiality.
• Well organized and have excellent attention to detail.
• Intermediate level working with Windows Office and Google applications
• Experience with Data entry
• Ability to solve problems and reason deduction.
• Experience with E-VIPS credentialing software, NPI registry, and CAQH.

Qualifications: BA in Organizational Leadership with 4 years of Experience

• Strong computer and data entry skills such as Microsoft Word, Excel and Outlook
• Experience with Salesforce 
• Excellent customer service skills
• Professional level written and oral communication skills
• Strong and effective negotiation skills
• Excellent organization, prioritization and time management skills
• Effective analytical and problem-solving abilities
• Effective written and verbal communication skills. 
• Highly organized and possess strong interpersonal skills. 
• Knowledge of NCQA credentialing standards as well as state and regulatory credentialing requirements.
• Computer literacy and proficiency in Microsoft Windows

Qualifications: BS in Psychology with 3 years of Experience