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Organization TypePublic Interest
Years of Experience
Date Last Verified
Credentialing Specialist Duties: Research, complete, and submit all regulatory applications required for participation in Medicare, Medicaid, Tri- Care, Veterans Affairs, Commercial Payors, and State and Local licenses. Ensure that all facilities’ licensure/certification documents are current and complete. Enter and update tracking systems and databases with facility information. Develop and maintain relationships with CMS, Federal, State and Local agencies, Tri-Care, Veterans Affairs, and Commercial Payors to stay current with and to anticipate regulatory, licensure, and certification changes and new legal requirements recovery programs. Maintain current knowledge of rules, regulations, and applications. Serve as a company resource for interpretation of Federal, State and Local agencies, Tri-Care, and Veteran Affairs program regulations governing recovery programs in consultation with management. Complete special projects and manage projects as assigned. Work overtime with little or no notice, as needed. Attend team meetings, phone conferences, and training, as needed. Participate in company meetings and conference calls, as required. Assist with coverage during staffing shortages and leaves of absence. Know, understand, and follow teammate guidelines, employment policies, and department or company procedures. Consistent, regular, punctual attendance, as scheduled, is an essential responsibility of this position. Draft routine documents, as requested. Work on other projects as assigned.
Qualification and Experience
Requirements: Undergraduate degree and paralegal certificate (ABA approved program) or undergraduate degree in paralegal studies (ABA approved program) or at least 5-years of job related experience. 5-7 years’ of progressively responsible hands-on licensure, certification and credentialing experience in combined areas of Mergers & Acquisitions, Healthcare, and basic Regulatory and Corporate law (required). 3-5 years of licensure, certification and credentialing experience in private law firm (preferred). 3-5 years’ experience with progressive technology for utilization of electronic document storage system (required). 5-7 years’ experience with researching, completing and submitting licensure, certification and credentialing applications for licensure or participation in federal, government or commercial payor programs. 5-7 years’ experience with communication, correspondence and follow-up with to state agencies, Centers for Medicare & Medicaid Services (CMS), Fiscal Intermediaries, Medicaid, Tri-Care, Veterans Affairs and commercial payors. Ability to review and understand transactional documents, core corporate records, standard healthcare operating documentation, recognize and understand both stated and implied deadlines (required). Advanced working knowledge of corporate records (required). Complete understanding of the natural process of entity formation and the lineage of parent companies to subsidiary entities (required). Ability to work overtime with little or no notice, as needed (required). Working knowledge and familiarity with common “deal terms” used in M&A transactions, preferably in a healthcare environment (required). Superb organizational skills and meticulous attention to detail (required). Must be a proven team player willing to pitch-in on projects outside of normal responsibilities. Ability to balance workload amid interruption and change in priorities, potentially multiple times within the same work day (required). Advanced word processing skills REQUIRED, including advanced work in Adobe Acrobat Professional, Microsoft Word Tables, quick turn-around time for document preparation and complex revisions, and Excel spreadsheets. Ability to work well under pressure. Provide support to Assistant Vice President, Legal Operations and Provider Enrollment and Legal, as directed. This position does not utilize or have access to administrative support. Successful candidate must be fully self-sufficient in all job requirements, including advanced word processing. Ability to maintain strict confidentiality regarding all company matters. Ability to read and interpret written information; write clearly and informatively; edit work for spelling and grammar. Ability to speak clearly and persuasively in positive or negative situations; listen and understand clarification; respond well to questions; demonstrate group presentation skills; and participate in meetings. Expert knowledge of Microsoft Word, Excel, Outlook, and Adobe Acrobat Professional. Working knowledge of PowerPoint. Familiarity and comfort level with maintaining multiple checklists and logs. If in personal recovery, a 2+ years clean and sober.
Job ID: 2018-1400
Company infoHiring Coordinator