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Credentialing Specialist
Greensboro, NC
Job Description
Credentialing Specialist
ID
2024-21999
| Location | CHAPS Building | Work Location | US-NC-Greensboro | Division : Name | Cone Health Medical Group | Department : Name | MCPS-Physent-Enterprise Admi | Category | PROFESSIONAL/MNGMNT | Position Sub-Category | PROFESSIONAL/MNGMNT | Position Type | Full Time (40 hours/week) | Employment Type | Employee | Exempt/NonExempt | Exempt | FTE | 1.00 | Workforce Status | Hybrid I | Work Hours | 40.00 | Provider Schedule (specific schedule) | 8am-5pm M-F | On call Required | No | Sub Category | Professional/Management |
Talent Pool: Professional/Management
| This position is responsible for enrolling/credentialing the Health System?s individual providers in government (Medicare/Medicaid, etc.) and managed care plans as required by the regulations or contracts governing these plans. |
| Complete credentialing and re-credentialing applications for these individuals in an accurate and timely manner -------------------------------------------------- Maintain a database of physicians and non-physician practitioners (CRNA-s, physician assistants, nurse practitioners, etc.) for whom the Health System is responsible for billing and/or managed care contracting. The database should contain participation status with government programs and managed care plans, effective dates of participation, re-enrollment deadlines and requirements, provider numbers and credentials -------------------------------------------------- Coordinate payor enrollment activities with internal credentialing functions performed by Medical Staff Services. Notify contracted payors of changes to provider panels -------------------------------------------------- Maintain an understanding of licensure and certification requirements in order to coordinate the enrollment process related to these activities -------------------------------------------------- |
| EDUCATION: |
| Bachelors, Preferred |
| EXPERIENCE: |
| 3 years, Preferred 3 years experience in Provider Credentialing preferred. CACTUS experience preferred. |
| LICENSURE/CERTIFICATION/REGISTRY/LISTING: |
| REQUIRED PREFERRED |
Cone Health is an Equal Opportunity Employer and committed to providing equal opportunity employment opportunities for applicants and employees. All employees and applicants for employment will be evaluated on the basis of their qualifications, ability, and performance without regard to race, religion, age sex, sexual orientation, gender identity, veteran's status, ethnicity, national origin, disability, color, or as otherwise protected by law.
Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
3 years
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