Senior Credentialing Specialist (Remote)

Description

WHO WE ARE

Founded in 1983, the Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputation for excellence and achieve continual improvement.

 

At MRIoA, we believe our employees are the key to our success. Here, you are more than just a cog in the machine – you are a valued member of our team.

WE OFFER

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.

POSITION OVERVIEW

Middle level position responsible for overseeing credentialing and recredentialing of clinical personnel. The Senior Credentialing Specialist is responsible for overseeing the day-to-day credentialing activities for healthcare providers while serving as the subject matter expert and first-line resource for a team of credentialing coordinators. This role ensures all credentialing processes are performed in compliance with regulatory and accreditation standards, and supports process improvements, training, and team performance to ensure timely and accurate provider onboarding and maintenance. 

Roles:

• To support the designated activities of the Credentialing Team
• To provide company-wide direction, guidance and support in the area of credentialing and credentialing
• To serve as an advocate for the Clinical Reviewers and act as their liaison
• Member of the Credentialing and Reviewer Assessment Committees

Major Responsibilities or Assigned Duties:

• Credential and recredential clinical reviewers
• Complete application and screening process
• Review primary source verification and licensing for applicants
• Present final applications to CMO or designated clinical representative
• Present applicants for approval to the Credentialing Committee
• Maintain internal systems with current licenses and certifications for all clinical personnel.
• Provide applicants with timely responses to their questions and concerns.
• Complete additional tasks, as requested, to support the credentialing team and reviewer needs.
• Provide timely updates and open communication with the Director of Provider Relations
• Support all Quality Management initiatives as applicable
• Participate in the Complaint process
• Support all Compliance program activities
• Maintain a flexible schedule
• Actively participate in company meetings and committees as requested
• Complete other duties as requested

Additional Responsibilities

• SME on credentialing software platform (CredentialStream)
• Create and maintain system workflows. Actively seek out system and process improvement opportunities.
• Drive a relationship with the vendor to ensure the needs of the Company are met through a mutually beneficial business relationship and support
• Build and maintain credentialing/recredentialing applications, reviewer communication templates, and committee communication structures
• Act as liaison between credentialing team and other internal departments, including developers, Business Intelligence, and Compliance for all system builds, maintenance, and training
• Responsible for providing training on credentialing/recredentialing to new team members, helping to conduct quality audits as needed. Partner with Training and other teams to build process maps, procedure guidelines, and other documentation to be able to train team members and quickly showcase internal policies as requested.
• Special projects as assigned

Requirements

Experience:

• At least 3 years’ experience in medical credentialing
• Certified provider credentialing specialist (CPCS) preferred
• Experience with credentialing software (CredentialStream preferred)
• Experience in providing small-group or individual training preferred

Skills

• Exceptional customer service skills
• Strong analytical skills
• Strong oral and written communication skills
• Exceptional orientation to detail
• Excellent organizational skills
• Ability to work under pressure and meet deadlines
• Strong working knowledge of managed care and utilization review accreditation standards and multi-state regulatory requirements
• Personal computer literacy and high competency in use of Adobe PDF, Microsoft Word and