Complete credentialing and recredentialing of practitioners and organizational providers based on State and Federal regulations, accreditation standards and CLIENT business requirements.



Provide analytical support, problem identification and facilitate resolutions to complete credentialing processes utilizing CLIENT’s electronic Credentialing system.



Analyze and compare credentialing data between the Council for Affordable Quality Healthcare (CAQH) database and CLIENT’s credentialing system, Portico.



Evaluate and investigate practitioner state licenses for actions, sanctions and/or malpractice claims history to process accordingly with summaries created in electronic file for presentation to CLIENT’s Enterprise Credentialing Committee.



Perform board certification and eligibility analysis for Initial Credentialing of New Graduates.



 



Requirements



Must have technical ability to self-monitor individual workload assigned in credentialing system and log issues for Supervisor review.



Knowledge of related state/federal regulations, NCQA, DIFS, MDHHS and CMS standards for credentialing required.



Excellent organizational skills and ability to prioritize multiple case files to meet required timelines.



Intermediate knowledge of Microsoft Word and Excel required.



Ability to work independently and/or in a team environment.



Associates degree required.



Certified Provider Credentialing Specialist (CPCS) - preferred.



Registered Health Information Technician (RHIT) - preferred.



 



Preferred:



Two to Five years’ work experience in provider enrollment, credentialing and/or contracting related field preferred.



 



As an equal opportunity employer, ICONMA prides itself on creating an employment environment that supports and encourages the abilities of all persons regardless of race, color, gender, age, sexual orientation, citizenship, or disability.