Job detail

Ancillary Credentialing Rep

The Health Plan of West Virginia Inc

#Regulatory Compliance #Medical Terminology #Medical Coding #Healthcare Administration #Medicare #NCQA #CMS #BMS #HEART

Quick overview

Responsible for the credentialing and recredentialing of ancillary providers in compliance with NCQA, Medicare, and state policies. Tasks include monitoring application status, performing data entry in provider systems, and assisting with internal and external audits.

Requirements summary

Requires an Associate's degree or high school diploma with two years of related healthcare experience. A Bachelor's degree, CPCS certification, and previous credentialing experience are desired.

high schoolassociate degreebachelor degreeprofessional certificateMulti-taskingProblem SolvingInterpersonal CommunicationRegulatory ComplianceMedical TerminologyMicrosoft OfficeData EntryMedical CodingCritical ThinkingCredentialingAudit AssistanceAdobe Acrobat

Job description

Under the direct supervision of the Manager of Provider Information Management, responsible for credentialing of ancillary providers and associated activities in support of the credentialing process as outlined in THP policy CR-07 in accordance with established Health Plan credentialing policies following NCQA, Medicare, the state of West Virginia, West Virginia Medicaid, and the state of Ohio policies and procedures.

Required

1.
Associates Degree or high school diploma/equivalent and two years related healthcare experience.
2.
Strong organizational, interpersonal, and critical thinking skills.
3.
Excellent communication skills, both written and verbal.
4.
Ability to multi-task, prioritize workload to meet deadlines, and pay meticulous attention to detail.
5.
Ability to troubleshoot, problem solve and work as a team as well as independently 6.
Experience in personal computer software applications such as Microsoft Office (Word, Excel) and Adobe Acrobat.

Desired

1. Bachelors Degree. 2. Previous credentialing experience. 3. CPCS Certification. 4. Experience with data systems. 5. Knowledge of medical coding and terminology.

Responsibilities

Performs ancillary credentialing and recredentialing functions
Daily monitoring of application status and documents progress to ensure compliance
Review and process ancillary initial credentialing and recredentialing applications and supporting documentation to identify possible issues. Follows up with responsible party to obtain missing information.
Ensure that recredentialing applications are completed timely to prevent any lapse in participation
Identifies credentialing applications with variances and complies information for management review.
Accurate data entry, document scanning, and navigation of provider data systems.
Adheres to all policies and procedures of The Health Plan and other regulatory/governing entities as well as following standards established by NCQA, CMS, BMS, and the states of West Virginia and Ohio.
Assists with national, state, and internal audits.