Credentialing Specialist Job at Matrix Medical Network
Matrix Medical Network Scottsdale, AZ 85259
$17 an hour
Overview:
About Us:
Matrix Medical Network is proud to be a Diversity, Equity, Inclusion and Accountability Employer
Why Work at Matrix?
The Credentialing Specialist is responsible for credentialing and recredentialing Matrix Medical Network (Matrix) practitioners as well as ensuring enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing Matrix Credentialing Applications, performing primary source verification's and updating and maintaining Matrix credentialing database in accordance with internal policies and procedures, client health plan contracts, NCQA guidelines as well as applicable state and federal requirements.
Responsibilities
Matrix Medical Network is an Equal Employment Opportunity Employer. It is the policy of Matrix to provide equal employment opportunities without regard to race, color, religion, sex, gender identity or expression, pregnancy, age, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. It is also the policy of Matrix that qualified individuals with disabilities receive equal opportunity in regard to job application procedures, hiring, and all aspects of the employment process. Matrix is committed to the full inclusion of all qualified individuals. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of Matrix to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, pre-employment testing, to otherwise participate in the selection process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact MatrixHR@matrixhealth.net.
Credentialing Specialist - Remote or Scottsdale AZ 85257 - Regular Shift - Work From Home Opportunity - Full Time - Salaried
Travel Requirements: No travel required.
Work Conditions: General office environment.
Matrix Medical Network is an Equal Employment Opportunity Employer. It is the policy of Matrix to provide equal employment opportunities without regard to race, color, religion, sex, gender identity or expression, pregnancy, age, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. It is also the policy of Matrix that qualified individuals with disabilities receive equal opportunity in regard to job application procedures, hiring, and all aspects of the employment process. Matrix is committed to the full inclusion of all qualified individuals. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of Matrix to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, pre-employment testing, to otherwise participate in the selection process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact MatrixHR@matrixhealth.net.
Credentialing Specialist
(Remote)
About Us:
Matrix Medical Network is a leading clinical services organization that supports the needs of diverse and vulnerable populations, working with millions of individuals across the country to assess and help them manage their health risks through our large network of clinicians. We support Medicare Advantage, Managed Medicaid and Commercial plans; serving populations of all ages, from seniors to other high-risk individuals.
Matrix colleagues understand the important role every department plays in helping the members and customers we serve have the best experience possible across all touchpoints. Join our team and help create innovative strategies and solutions to make quality healthcare more accessible!
Matrix Medical Network is proud to be a Diversity, Equity, Inclusion and Accountability Employer
Why Work at Matrix?
- The opportunity to work with one of the fastest growing companies in healthcare whose vision is to provide unparalleled quality and value to providers and members.
- A chance to work with great people on exciting projects.
- Our opportunities allow you to leverage your expertise and compassion, making a direct impact to the health and well-being of members.
- Competitive Compensation: Be rewarded for your effort and passion while making a difference in the community.
About the role:
Type: Temporary until October
Compensation: $17 an hour to $25 an hour
Location: Primary location: Remote (of if you desire to be in office 9201 E. Mountain View Road, Scottsdale, AZ 85258)
Hours: Full Time Days
Benefits Offered to include: Medical, Dental, Vision, paid time off, paid holidays, 401K with company matching, voluntary life insurance, short term disability, long term disability, employee assistance program, health savings account, flexible spending accounts, additional voluntary benefits and tuition discount available.
What to Expect:
The Credentialing Specialist is responsible for credentialing and recredentialing Matrix Medical Network (Matrix) practitioners as well as ensuring enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing Matrix Credentialing Applications, performing primary source verification's and updating and maintaining Matrix credentialing database in accordance with internal policies and procedures, client health plan contracts, NCQA guidelines as well as applicable state and federal requirements.
Responsibilities
- Perform the initial credentialing and recredentialing functions for employed and contracted Matrix practitioners, which may include collaborating physicians and Locum Tenens.
- Review practitioner applications for completion and accuracy and ensure appropriate follow-up; monitor and report on the credentialing progress of each practitioner
- Maintain timely and accurate data entry and periodically revise practitioner data in the Matrix credentialing database
- Maintain practitioner paper and electronic data files for Matrix practitioners; use the CAQH system to submit practitioner data as required by some client health plans to credential individual practitioners
- Ensure timely and accurate credentialing and recredentialing application submissions for each practitioner as it relates to each client health plan; monitor and report progress of each practitioner
- Enroll practitioners with all appropriate client health plans; monitor and report on progress of each practitioner
- Ensure all practitioners who require collaboration agreements are appropriately assigned to a collaborating physician and the agreement is executed by both parties; monitor and report progress of each practitioner
- Ensure employed practitioners are enrolled under the Matrix professional liability insurance plan; monitor and report progress on each practitioner
- Respond to all practitioner, client health plan and internal inquiries in a timely manner within one (1) business day Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed
- Matrix timeframes as outlined in the policies and procedures, assisting practitioners with timely renewal as appropriate and escalating to manager and field management as appropriate
- Conduct sanctions and compliance monitoring and alert Manager of any undisclosed negative findings immediately
- Assist traveling practitioners with obtaining new state licenses in areas identified by the clinical management team; monitor and report progress of each practitioner
- Adhere to Matrix policies and procedures including timely delivery of completed work and use of resources Identify, analyze and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners and ultimately bill and obtain reimbursement for services rendered; discover and convey problems to Manager so that the optimal course of action is taken by making sound decisions in accordance with department and corporate guidelines
- Utilize extensive internet and telephone communication to obtain critical pertinent information
- Keep Manager informed of potential credentialing or enrollment issues Other duties as assigned
Must Haves:
- Associates or Bachelors in Business, Finance, Health Care or related field or high school diploma and relevant combination of education and experience
- Experience with medical and professional credentialing processes, policies and procedures, including delegated credentialing requirements
- Familiarity with practitioner billing and claims payment system requirements as related to practitioner enrollment
- Credentialing experience in a health care setting to include practitioner enrollment, credentialing or network services experience
- Demonstrated ability to work independently
- Ability to manage multiple projects efficiently and accurately
- Strong analytical skills needed to assess compliance, record, analyze and interpret data into meaningful formats
- Strong written and verbal communication skills
- Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external clients
- Ability to adapt to change and meet deadlines
- Excellent attention to detail and high degree of accuracy
- Requires exceptional critical thinking skills, sounds judgment and the ability to communicate in an articulate and sensitive manner with practitioners, administrators, legal counsel and client credentialing personnel
Preferred Qualifications:
- Certified Practitioner Credentialing Specialist (CPCS) Experience with MD-Staff or similar practitioner credentialing, data collection and record management system
- Experience with NCQA, URAC and/or The Joint Commission guidelines and standards related to credentialing
- Experience with MS Office
Our Culture:
- We have a clear vision of where we are going, and we are guided by core values that embody our organization and our culture.
- We emphasizes innovation and growth, and you will be given the opportunities and tools to develop personally and professionally.
- We encourage and celebrate collaboration.
- We have a deep commitment to positively impact the communities in which we work and to make a difference in the lives of who we serve.
- As a clinical organization, we support vaccinations because we care about the health and safety of our colleagues and those we serve. Moreover, our clients are increasingly expecting us to be vaccinated due to the vulnerability of those we serve. As such, Matrix Medical Network requires that all team members are fully vaccinated against Influenza and COVID-19, unless they are eligible for a specific exemption.
Matrix Medical Network is an Equal Employment Opportunity Employer. It is the policy of Matrix to provide equal employment opportunities without regard to race, color, religion, sex, gender identity or expression, pregnancy, age, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. It is also the policy of Matrix that qualified individuals with disabilities receive equal opportunity in regard to job application procedures, hiring, and all aspects of the employment process. Matrix is committed to the full inclusion of all qualified individuals. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of Matrix to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, pre-employment testing, to otherwise participate in the selection process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact MatrixHR@matrixhealth.net.
Credentialing Specialist - Remote or Scottsdale AZ 85257 - Regular Shift - Work From Home Opportunity - Full Time - Salaried
Position Requirements
- Experience with medical and professional credentialing processes, policies and procedures, including delegated credentialing requirements Familiarity with practitioner billing and claims payment system requirements as related to practitioner enrollment
- Up to three years credentialing experience in a health care setting to include up to two years of practitioner enrollment, credentialing or network services experience
- Demonstrated ability to work independently
- Ability to manage multiple projects efficiently and accurately
- Strong analytical skills needed to assess compliance, record, analyze and interpret data into meaningful formats
- Strong written and verbal communication skills
- Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external clients
- Ability to adapt to change and meet deadlines
- Excellent attention to detail and high degree of accuracy
- Requires exceptional critical thinking skills, sounds judgment and the ability to communicate in an articulate and sensitive manner with practitioners, administrators, legal counsel and client credentialing personnel
Educational Requirements Associates or Bachelors in Business, Finance, Health Care or related field or high school diploma and relevant combination of education and experience
- Preferred
- Certified Practitioner Credentialing Specialist (CPCS) Experience with MD-Staff or similar practitioner credentialing, data collection and record management system
- Experience with NCQA, URAC and/or The Joint Commission guidelines and standards related to credentialing
- Experience with MS Office
Supervisory Responsibility
: No supervisory responsibilities.
Travel Requirements: No travel required.
Work Conditions: General office environment.
Matrix Medical Network is an Equal Employment Opportunity Employer. It is the policy of Matrix to provide equal employment opportunities without regard to race, color, religion, sex, gender identity or expression, pregnancy, age, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. It is also the policy of Matrix that qualified individuals with disabilities receive equal opportunity in regard to job application procedures, hiring, and all aspects of the employment process. Matrix is committed to the full inclusion of all qualified individuals. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of Matrix to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, pre-employment testing, to otherwise participate in the selection process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact MatrixHR@matrixhealth.net.
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