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Open nowPosted yesterday

Delegated Credentialing Specialist I - Managed Care - Days - FT

Memorial Hospital at Gulfport331 open roles

Where
Gulfport, MS, United States
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Your applicationOpen nowDelegated Credentialing Specialist I - Managed Care - Days - FTMemorial Hospital at Gulfport · Gulfport, MS, United States

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The clock on this job

Early applications get read.

13.9% of postings close within 7 days. Measured by our own scanner across the market. Memorial Hospital at Gulfport postings stay open a median of 15 days.

Share of postings closed within
  1. 2.2%1 day
  2. 4.7%3 days
  3. 13.9%7 days
  4. 22.4%14 days
  5. 38.1%30 days
  6. 59.0%60 days
This job: posted yesterday

Memorial Hospital at Gulfport median: 15 days open

The posting

Job Description

The Delegated Credentialing Specialist I is responsible for assisting in credentialing with the appropriate delegated insurance plans, governmental agencies and any other participating insurance plans. The Specialist I provides support in processes related to the preparation and processing of information and monitors compliance with regulatory and accrediting bodies as well as delegated rules and regulations. The Specialist I maintains accurate and up to date data within the relevant databases.

Responsibilities

  • Provides support in compiling and completing physician and provider credentialing forms for appropriate payor delegations Aids in the verification and documentation processes for submitted applications Assists with the completion of physician and provider participating contracts and credentialing files Collaborates with insurance plan providers and representatives to obtain and complete specific payer credentialing forms and applications
  • Participates in preparing and providing information to various departments and external entities Communicates with appropriate billing staff regarding the status of a provider's enrollment with individual payers Facilitates provider-related research based on suspended claims, denial issues related to the enrollment process and other feedback opportunities Provides requested information to authorized agencies for audits and reviews Ensures compliance with delegation monitoring and oversight requirements for credentialing functions Collaborates with the various departments to conduct the timely credentialing delegation audits Participates in post-audit results meetings with insurance representatives and contributes to the resolution of any audit findings Attends provider onboarding to obtain additional information/signatures from providers
  • Maintains and updates physicians and provider information in the applicable databases Maintains credentialing database and provider billing number tracking sheet Monitors and tracks license and certification expirations and renewals and provider information Maintains physician and provider directory information for departments and hospital Performs tracking and follow-up to ensure provider numbers are linked to appropriate entity and location

Qualifications

Education:

Required

  • High School or GED

Licensure or Certification Requirements:

Preferred

  • Certified Provider Credentialing Specialist (CPCS) from the National Association of Medical Staff Services

Experience:

Required

  • 1 year of experience with payor credentialing or related

Skills:

  • Strong verbal and written communication skills
  • Data entry with minimal errors
  • Seeking solutions using appropriate methodologies
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