Credentialing Special Level I

4 days ago

Mandaluyong City, National Capital Region, Philippines MedRisk LLC Full time ₱900,000 - ₱1,200,000 per year

Position Summary

Maintaining a clean and updated database is crucial for the success of MedRisk. All business units rely on updated and valid information to ensure our providers and clients are receiving the services they come to expect. We also need to ensure we are compliant with the requirements to pass our internal and external audits. The Credentialing Specialist team has to work closely with our network providers to ensure we gather all necessary paperwork to credential a provider according to our contract with the providers.

Primary Duties & Responsibilities

  • Credentialing Specialist will review and screen Re-credentialing applications for completeness, accuracy, and compliance with federal, state, local and MedRisk regulations, guidelines, policies, and standards.
  • Credentialing Specialist will follow workflows for communication via Call, Email, and Fax with providers to gather credentialing documents.
  • Credentialing Specialist will review all received Credentialing documents and certifications to ensure accuracy and within good standing with appropriate state agencies.
  • Credentialing Specialist will review and update all external and internal provider request such as Adding and Removing Services, Locations, Therapists, and Change in Provider demographics.
  • Credentialing Specialist will maintain internal Provider system to ensure all information is accurate.
  • Credentialing Specialist will monitor provider accounts ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
  • Other Duties Assigned

Qualifications

  • Strong organizational skills with attention to detail and ability to prioritize tasks, work under pressure in faced pace environment.
  • Demonstrate exceptional written and oral communication skills
  • Demonstrated computer skills. MS Office proficiency, as well as database programs.
  • Minimum of two years demonstrated experience in professional health care staff credentialing is preferred.
  • Bachelor's degree strongly preferred; equivalent work experience may be substituted.

Competencies (choose at least 4)

  • Customer Focus
  • Integrity and Trust
  • Functional/Technical Skills
  • Priority Setting

  • Ethics and Values

  • Agility

  • Attention to details

Working Conditions & Physical Requirements

The work environment characteristics described here is representative of those of a standard office setting. The noise level in the work environment is usually moderate.

While performing the duties of this job, the employee must be able to remain in a stationary position over 50% of the work day; move about inside the office to access files or office equipment; use hands to finger, handle, or feel objects, tools, or controls to operate a computer and other office productivity machines; reach with hands and arms; must communicate and converse with co-workers; and detect/discern information accurately. Specific vision abilities required by this job include close vision and the ability to adjust focus. The employee must occasionally lift and/or move up to 10 pounds.

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