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Remote Credentialing Analyst // 5 Years Required
Posted Friday, June 30, 2023
Posting ID: JP-003877293
Greenwood Village, CO
- Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.
- Facilitates all aspects of credentialing, including initial applications, re-credentialing applications, expirables process, as well as maintain all Medicare and Medicaid enrollments for all pharmacies, and all other providers
- Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies
- Responsible for the accuracy and integrity of the credentialing database systems and related applications
- Leads, coordinates, and monitors the review and analysis of pharmacy and practitioner applications and accompanying documents, ensuring applicant eligibility.
- Conducts research and primary source verification of all components of the application.
- Identifies issues that require additional investigation and evaluation, validates any sanctions and ensures appropriate follow up.
- Prepares credentials for all payers ensuring completion.
- Responds to inquiries from all payers and also interfaces with internal and external customers on day-to-day credentialing and issues as they arise.
- Assists with managed care credentialing audits; conducts internal file audits.
- Utilizes the NCPDP and CAQH credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
- Monitors initial, re-credentialing applications for all pharmacies, infusion clinics, Allied Health Professional staff, ensuring compliance with regulatory bodies.
- Performs miscellaneous job-related duties as assigned.
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers / pharmacies.
- Sets up and maintains provider information in online credentialing databases and system.
- Six years of experience in the medical field, required
- Minimum of four (4) years directly related to Managed Care credentialing
- Certification/Licensure NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM)
- OR Certified Provider Credentials Specialist (CPCS)
- OR actively pursuing certification, preferred.
Recruiter: Cody Wessbecker
Phone: (303) 224-4514
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.