Evolent · 1 day ago

Specialist, Credentialing Operations - NCQA Experience a Must

United States

Full-time

Remote

Entry, Mid Level

$25/hr - $27/hr

2+ years exp

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Responsibilities

Maintenance of provider data within the credentialing platform.

Ticket intake and triage for internal/externally submitted tickets.

Responsible for credentialing and re-credentialing files, including both Type I and Type II files.

Maintain working knowledge of and comply with NCQA credentialing and recredentialing guidelines.

Maintain working knowledge of and comply with partner specific credentialing and recredentialing guidelines, policies, and procedures.

Ongoing monthly monitoring of exclusions, sanctions, and adverse events.

Represent Credentialing department in meetings and delivering special projects and maintaining concurrent projects as assigned.

Establishing and maintaining excellent relationships, internally and externally including communication to the leadership team.

Maintain contractual service level and/or operational level agreements, as applicable.

Maintenance of credentialing and provider data management systems, including the Counsel of Affordable Quality Healthcare (CAQH), Credentialing Systems, SPayer, Symplr and proprietary claims system and Power BI Tool.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Credentialing OperationsNCQA guidelinesProvider Data ManagementMicrosoft Office SuiteHealthcare experienceUS healthcare understandingProvider enrollmentProvider servicesConfigurationPower BI ToolSPayerSymplrCAQH