PROVIDER ENR & DATA SPECIALIST

Location
Richmond, VA
Posted
Jan 26, 2017
Closes
Mar 31, 2017
Function
Nurse
Industry
Healthcare
Hours
Full Time
Job Description: Verification and management of provider application and credentialing documentation required for health plan participation. Maintains database of providers recently credentialed, or in the credentialing pipeline. Responsible for the coordination of provider contracting and re-contracting projects, including document production, distribution process and response tracking. Maintains documentation of provider enrollment, credentialing, service and contracting in the departmental provider data systems. Supports Contract Managers and department leadership in network management by producing network and GeoAccess reports, as well as preparation and submission of provider reporting required by local and state regulators, CMS and customers. Manages special projects as assigned.

Education Level
High School Grad or Equivalent

Experience
Required: Credentialing - 1 year, Healthcare - 1 year, Managed Care - 1 year

Preferred: None, unless noted in the “Other” section below

License
None, unless noted in the “Other” section below

Skills
None, unless noted in the “Other” section below

Other
1 year of credentialing experience required. 1 year of healthcare or managed care experience required.

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