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Credentialing Administrator in Chesapeake, VA at Beacon Health Options

Date Posted: 4/8/2019

Job Snapshot

Job Description

Summary:

The Credentialing Administrator will be responsible for all facets of the credentialing process including knowledge of Beacon Health Options, i.e. client specific criteria, accreditation standards i.e. NCQA, URAC, and JCAHO, credentialing law, legal issues, state statutes, CMS requirements, Federal regulatory compliance and external reporting requirements related to quality of care issues/adverse incidents. The incumbent must have knowledge of credentialing policies and procedures including support of the credentialing committees ((Local Credentialing Committees (LCC), National Credentialing Committee (NCC) and the fair hearing process.

Responsibilities: 

The Credentialing Administrator will be responsible for supporting the credentialing process by maintaining primary accountability for at least one major functions outlined below:

  • Conducting investigation and information gathering when outliers are present (i.e. malpractice claims/judgments, disciplinary action and/or sanctions are pending or present on an applicant or a network provider) during the credentialing/re-credentialing process or as identified in between credentialing cycles.
  • On-going monitoring of sanctions by maintaining and reviewing the disciplinary action/sanction reports released by the State license boards or the List of Excluded Individuals and Entities (LEIE) monthly database released by the Office of the Inspector General within the department’s required time frame (30-days from release of the entity).
  • Identification of providers who require a site visit and coordinating the on-site treatment record keeping practice review with the Provider Relations Department and the Credentialing Specialist responsible for the file.  This includes scoring the tool once it is returned to the department and coordinating notification to the provider, Provider Relations and the Credentialing Specialist upon completion. 
  • Responsible for accurate and timely composition of the committee advisory forms which includes gathering pertinent data necessary to make an informed decision.  The advisory form includes details outlining the situation/issue and the appropriate recommendations based on the internal hierarchical process.  The Credentialing Coordinator may be required to read and interpret legal documents (from attorneys, courts and State license boards) to create an accurate summary of all relevant/factual information for the Committee to render an informed, effective decision.

Requirements: 

  • Minimum of three years of experience in the healthcare or insurance industry
  • One to three years of Credentialing experience, preferably in healthcare 
  • Strong customer service skills, ability to interface with all levels 
  • Excellent verbal and written communication skills
  • Quick study, able to work independently with minimal supervision
  • Well organized, able to multi-task and meet deadline requirements
  • Team player
  • Computer literate, i.e. MS Office, Internet Searches

Education:

Bachelors’ degree preferred, High School Diploma or equivalent, required

Licenses:

CPCS Certification, highly desirable

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.