Credentialing Data Integrity Manager

Legacy Community Health

Houston, TX, USA

Full time

Healthcare / Community Health & Mental Health

Mar 18

This job is no longer accepting applications.

The Credentialing Data Integrity Manager is responsible for the overall accuracy of the delegated rosters, for Medicare compliance roster attestations and serving as liaison between Legacy and outside organizations and external customers

Essential Functions

  • Prepare and maintain credentialing files and reports for all individual providers including maintenance of credentialing software, provider rosters and spreadsheets to comply with group delegation requirements.
  • Obtains and verifies credentialing documents required upon provider onboarding.
  • Ensures compliance with the appropriate accrediting and regulatory agencies in relations to credentialing functions including application management and primary source verification
  • Coordinates the management of the expirables process to ensure all contracted provider licenses and certificates remain current, ensuring appropriate notification prior to expiration Update and maintain CAQH records according to provider specifications.
  • Revises general aspects of credentialing process as necessary; makes recommendations for changes in policies and procedures; assist in developing new process improvement strategies; maintains data integrity protocols and procedures
  • Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts.
  • Conduct file reviews to ensure documents meet credentialing standards and ensure all records meet standards set by carriers as well as FQHC guidelines
  • Maintains quarterly payor specific rosters in accordance to CMS standards; conducts all follow up steps until payor approval/completion is obtained
  • Assist in quarterly CAQH mass quarterly attestation
  • Process and file applications with third party payors according to each payor’s individual requirements and addresses/corrects discrepancies as requested by payors.
  • File provider practice change notifications and perform follow up duties till confirmed complete by payors.
  • Enroll provider in Medicare/Medicaid as prescribed by each program requirements; Enrolls facilities in Medicare/Medicaid programs; Address enrollment disconnects in regards to facility and providers
  • Complete requests for re-credentialing for both providers and facilities.
  • Accept and process requests from payers for credentialing information/updates/new contracts and products
  • Answer questions, process requests from staff/providers related to credentialing information.
  • Participates in the Performance Improvement Program.
  • Performs other duties as assigned.

Education & Training Requirements

  • Bachelor’s Degree

Work Experience Required

  • Five (5) years’ experience in capacity as credentialing coordinator or credentialing specialist specializing in provider enrollment.

Benefits

9 Holiday + 1 Floating Holiday

PTO

403b Retirement Plan

Medical / Vision / Dental (if eligible)

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Legacy Community Health

Driving healthy change in our communities.

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