Provider Data Services Rep - 6 Month Assignment

Location: Jacksonville
Posted on: October 29, 2024

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.

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