Manager Cigna Rn Remote Jobs in Charleston, WV (NOW HIRING)

TheCredentialing Specialistwill report toOneOncology'sCredentialing Supervisor.The credentialing specialistis responsible forall aspects of theprivilegingand credentialing process for physicians and allied health professionals. The Specialist will process applications, verify information, research application details, andassureprocesses arein accordance withmedialstaff procedures. The specialists will provide consistent,accurate, andtimelycredentialing support, enhancing theorganization'sability to provide professional services. Work includes theaccurate,timelyand documented verification of the information provided by the application and maintenance of the highly confidential credentialing related files.

Responsibilities

• Credentialing and re-credentialing of physicians andadvanced practice providers.

• Completion, submission and tracking of credentialing applications with all managed care organizations and hospitals.

• Applyforandvalidatehospital privileges.

• Obtain malpractice insurance policy.

• Notification to staffofcompletion of credentialing for scheduling and billing.

• Maintain and update CAQH online credentialingapplicationfor all providers quarterly. Database management/provider files.

• Maintain vital provider credentialing information via technology tool and hard copies of documents in provider files stored onOneOncologyplatform.

• Tracking andmaintainingall clinical licenses for nursing, pharmacy, and lab personnel.

• Provider continuing education

• Track continuing education credits for all providers.

• Notify providers of any deficiencies.

• Submit documentation if providers are audited.

• Termination of physician and/or allied health professional.

• Contact all MCO/hospitals/EMR to removeproviderwhohasleft practice, within30 daysof termination.

• Other tasks as assigned to drive our mission of improving the lives of everyone living with cancer.

Key Competencies

• Experience working with NCQA criteria andthird-partypayer regulations.

• Experience withcompleting hospital credentialing applications.

• Proficient with MS Office Suite (word, excel) andweb-basedapplications.

• Ability tomaintainverbal andwritten communicationsin a confidential manner.

• Detailoriented with strong organizational skills.

• Excellent interpersonal skills - teamplayerwhocanprioritize multiple responsibilities, manage a large workload within tight deadlines - works well under pressure and consistently meets deadlines, readily adapts tochange,and excels in aproductivity-basedenvironment.

• Demonstrates research and problem-solving skills.

Qualifications

• Current working knowledge of enrollment processes with Californiapayors, Commercial and Government.

• High school diploma and 2+ years of related experience.

• Bachelor's degree preferred.

• Industry experienceleading credentialing activitiesinlarge providerpractice(or multiple practices)isrequired.

• Certificationspreferredbut notrequired.

• Working remotewithTravel flexibilityas needed.

• Working Pacific Standard Time hours.