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Credentialing Specialist
About
The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare and Medicaid.
Requirements
Complete credentialing applications to add providers.
Maintain internal provider grid to ensure all information is accurate
Update each provider’s CAQH database file timely
Complete credentialing & re-credentialing applications for commercial payers
Work closely with the Revenue Cycle Director and billing staff
Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
Other duties as assigned
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MDM
Analyst
About
The MDM Analyst reports to the MDM/Data Governance Manager and is responsible for the end-to-end master data customer and product maintenance processes within U.S. Commercial Operations. This person is responsible for MDM data quality, processes and business rules.
Requirements
Responsible for daily MDM data steward activities
Responsible for defining MDM SOPs and Wis
Participate in MDM UAT testing
Responsible for understanding the end-to-end processes
Assist in the definition of master data sourcing and services strategies
Work with IT to coordinate and define business user impacts of MDM application
Responsible for customer and product data harmonization across multiple sources
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Data
Architect
About
Your central responsibility as the Data Architect will be to develop, optimize and oversee our company’s conceptual and logical data systems. Your duties may include preparing architect reports, monitoring the system, and supervising system migrations.
Requirements
Design and implement database solutions and models
Examine and identify database structural necessities
Oversee the migration of data from legacy systems
Prepare accurate database design and architecture reports
Responding to system problems in a timely manner
Educate staff members through training and individual support
Monitor the system performance by performing regular tests
Recommend solutions to improve new and existing database systems
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Medical Staff Coordinator
About
Coordinates administrative support services for the Medical Staff and assures that all credentialing and accreditation processes are completed and that only qualified and competent physicians and practitioners are appointed and reappointed to the hospital staff.
Requirements
Coordinates credentialing end-of-committee process
Coordinates receipt of credentialing and privileging applications
Prepares summary reports of credentialing/privileging recommendations
Assists in coordination, tracking and monitoring of the OPPE and FPPE process
Generates queries and reports from credentialing and privileging database
Assists with clinical privilege development and maintenance of database.
Interprets federal, state, local, and government/insurance agency regulations.
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