Provider Data Services Rep - 6 Month Assignment
Location: Jacksonville
Posted on: October 29, 2024
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Job Description:
This position exists to ensure accurate and timely
administration of the credentialing and recredentialing activity
that takes place for physician/providers in our Networks. The
individuals in this role perform the critical core business
activities associated with ensuring that we are in compliance with
regulatory and licensing agencies (NCQA, CMS, ACHA). The work
performed by these individuals include the accumulation and
research of specified documents, databases, Internet websites, etc
for the purpose of credentialing potential and existing providers.
Representative duties include, but are not limited to, the
following: Ensure that BCBSFL maintains a broad network of
qualified providers through credentialing and recredentialing
processes: ? Accumulate and research specified documents,
databases, Internet websites, etc. for the purpose of credentialing
potential and existing providers. (including CVO vendor) ? Ensure
compliance with various regulatory and licensing agencies. ?
Perform accurate and timely provider data research, collection,
verification and analysis. ? Compile provider data from various
legal documents, compliance websites and monitoring agencies to
support decisions for network participation. ? Analyze provider
data and translate complex court documents and legal proceedings
for discussion with Medical Consultants. ? Utilize continuous
process improvements to streamline credentialing cycle time. ?
Extract data from PIP (Provider Information Platform) to create
communication for provider notification. ? Independently plan,
organize and perform on-going inventory reduction strategies based
on changing deadline
Job Requirements: Required: ? High school diploma or equivalent ? 3
years healthcare related experience ? Experience with regulatory
agency requirements (NCQA, CMS, DEA, etc) ? MS Word Preferred: ?
Credentialing experience including website research ? Experience
with PIP ? Experience with Client Letter ? Experience with provider
demographic file maintenance ? Experience with contracting
processes
We are an equal employment opportunity employer and will consider
all qualified candidates without regard to disability or protected
veteran status.
Keywords: , Daytona Beach , Provider Data Services Rep - 6 Month Assignment, Healthcare , Jacksonville, Florida
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