How will this role have an impact?
This role will report to our Director of Credentialing.
What will you do?
- Queries appropriate organizations and evaluates responses to ensure provider compliance with NCQA standards
- Establishes and maintains a system for timely processing of credentialing/re-credentialing files in accordance with NCQA policies.
- Maintain up to date credentialing database.
- Review and process credentialing and re-credentialing files.
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
- Maintains professionalism at all times when communicating credentialing and/or background concerns with any provider
- Assembles all verified information and prepares files for presentation to the Credentialing Committee
- Assist with ongoing monitoring of contracted providers.
- Reviews all background screenings and record results.
- Utilizes the MD Staff credentialing database, optimizing efficiency, and performs query, report and document generation
- Monitors the initial, re-credentialing and expirables process.
- Assist with special projects.
- Be familiar with accreditation standards.
- Verify providers’ requirements for approval to work in specific states and plans.
- Provides administrative support to Director of Medical Staff Services and Credentialing Manager.
- Actively demonstrates teamwork at all times.
- Approve plan-specific provider assignments in Virtus.
- Respond for monthly audits.
- Respond to requests from various internal departments.
- Responsible for the security and privacy of any and all protected health information that may be accessed during normal work activities
We are looking for someone with:
- 3-5 years of successful work experience in a credentialing role
- NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) within 2 years of eligibility to certify.
- Intermediate skills in MS Office
Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across individuals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for individuals who need help the most. This leads to better outcomes and a better experience for everyone involved.
Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million individuals each year while helping payers and providers more effectively implement value-based care programs.
To learn more about how we’re driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com.
Above all, we provide care for those who need it most. We understand the benefits of a personalized approach to clinical encounters, and the importance of conversation, understanding, and sitting knee-to-knee with the patient in the best setting for care delivery: the home.