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8110 Gatehouse Road, Falls Church, VA 22042

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Centralized Credentialing Specialist

Fairfax Medical Campus 616986 Full Time 3300 Gallows Road, Falls Church, VA, 22042, US
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Job Description

As a Centralized Credentialing Specialist, you will identify extraordinary information, discrepancies, time gaps and obtain additional explanations/information as required. To help achieve our mission, you will communicate, as appropriate, to all interested parties. Processing practitioner applications for initial appointment, re-appointment, managed care enrollment and enrollment in federally funded healthcare programs is required. Your ability to play a proactive role in process improvement is of vital importance.

Job Responsibilities
 
  • Processes practitioner applications for initial appointment, re-appointment, managed care enrollment and enrollment in federally funded healthcare programs.
  • Processes 99 percent of applications within required timeframes, in accordance with policy.
  • Utilizes and maximizes use of credentialing software to ensure proper use of resources and cost savings.
  • Maintains a working knowledge of and ensures compliance of Medicare and Medicaid enrollment requirements for practitioners, state and federal regulations, Inova Health System hospital bylaws, credentialing criteria and department policies and procedures.
  • Provides excellent customer support to internal and external clients including prompt responses to requests for information/help.
  • Manages, supports and maintains credential files on all medical staff members and allied health professionals.
  • Consults and works with other hospital departments to coordinate processes.
  • Plays a proactive role in improving processes within department for maximum efficiency by participating/leading A3s or other process improvement activities.



Additional Requirements

 

Education:

High School or GED

Experience:

Experience in healthcare setting or customer service OR a bachelor’s degree in lieu of experience

Skills:

-Proficient in Microsoft Office

-Excellent customer service

-Excellent communication skills; both oral and written

-Organizational skills


Knowledge of The Joint Commission or NCQA standards. Proficiency in Office Suite.