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Credentialing Specialist

Company: Matrix Medical Network
Location: Scottsdale
Posted on: June 24, 2022

Job Description:

Overview Credentialing Specialist (Remote) Matrix, in partnership with its expert clinical advisory panel, offers customizable solutions across four distinct lines of business via in-home visits, telehealth, on-site support at medical facilities and businesses, and Mobile Health Clinics: * Matrix Clinical Solutions helps keep workers healthy and businesses run productively by designing custom workplace health solutions and providing testing, tracing, and clinical care solutions. Matrix also offers a safety verified certification program developed in collaboration with the Cleveland Clinic.
* Matrix Clinical Care helps seniors and other at-risk individuals enjoy a better quality of care, experience better health outcomes, and identify chronic conditions that may otherwise go undiagnosed.
* Matrix Clinical Trials provides rapid and scalable decentralized trial solutions to reach broad and diverse trial participant populations and improve the patient experience. Matrix adheres to the highest standards in quality, compliance, and data collection to accelerate trial completion timelines and support trial partners.
* Matrix Clinical Labs is a CLIA-certified and CAP-accredited laboratory that provides state-of-the-art diagnostic services and clinical testing support. Matrix Medical Network IT delivers capabilities using cutting edge technologies to support all these lines of business, including Mobile Tablet, Geo-spatial Analysis, Business Intelligence and Custom Business solutions. At Matrix, you will have endless opportunities to positively impact the communities in which we work and to affect the lives of health plan members who we serve. What we offer: * A chance to work with great people on exciting projects
* Make a difference by taking the time doing the work that saves lives that have positive and direct impact on the wellbeing of others
* The opportunity to work with a progressive company, who wants to make a difference Responsibilities About the role: Type: Full Time Salaried Compensation: $45,000 to $52,000 a year based on experience. Location: Primary location: Remote or 9201 E. Mountain View Road, Scottsdale, AZ 85258. Hours: Full Time Days Benefits Offered to include: Medical, Dental, Vision, PTO and holiday pay, 401K with company matching, voluntary life insurance, short term disability, long term disability, health savings account, flexible spending accounts. What to Expect: The Credentialing Specialist is responsible for credentialing and recredentialing Matrix Medical Network (Matrix) practitioners as well as ensuring enrollment with participating client health plans. Credentialing functions include, but are not limited to, processing Matrix Credentialing Applications, performing primary source verification's and updating and maintaining Matrix credentialing database in accordance with internal policies and procedures, client health plan contracts, NCQA guidelines as well as applicable state and federal requirements. Responsibilities: * Perform the initial credentialing and recredentialing functions for employed and contracted Matrix practitioners, which may include collaborating physicians and Locum Tenens.
* Review practitioner applications for completion and accuracy and ensure appropriate follow-up; monitor and report on the credentialing progress of each practitioner
* Maintain timely and accurate data entry and periodically revise practitioner data in the Matrix credentialing database
* Maintain practitioner paper and electronic data files for Matrix practitioners; use the CAQH system to submit practitioner data as required by some client health plans to credential individual practitioners
* Ensure timely and accurate credentialing and recredentialing application submissions for each practitioner as it relates to each client health plan; monitor and report progress of each practitioner
* Enroll practitioners with all appropriate client health plans; monitor and report on progress of each practitioner
* Ensure all practitioners who require collaboration agreements are appropriately assigned to a collaborating physician and the agreement is executed by both parties; monitor and report progress of each practitioner
* Ensure employed practitioners are enrolled under the Matrix professional liability insurance plan; monitor and report progress on each practitioner
* Respond to all practitioner, client health plan and internal inquiries in a timely manner within one (1) business day Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed
* Matrix timeframes as outlined in the policies and procedures, assisting practitioners with timely renewal as appropriate and escalating to manager and field management as appropriate
* Conduct sanctions and compliance monitoring and alert Manager of any undisclosed negative findings immediately
* Assist traveling practitioners with obtaining new state licenses in areas identified by the clinical management team; monitor and report progress of each practitioner
* Adhere to Matrix policies and procedures including timely delivery of completed work and use of resources Identify, analyze and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners and ultimately bill and obtain reimbursement for services rendered; discover and convey problems to Manager so that the optimal course of action is taken by making sound decisions in accordance with department and corporate guidelines
* Utilize extensive internet and telephone communication to obtain critical pertinent information
* Keep Manager informed of potential credentialing or enrollment issues Other duties as assigned Qualifications Must Haves: * Associates or Bachelors in Business, Finance, Health Care or related field or high school diploma and relevant combination of education and experience
* Experience with medical and professional credentialing processes, policies and procedures, including delegated credentialing requirements Familiarity with practitioner billing and claims payment system requirements as related to practitioner enrollment
* Up to three years credentialing experience in a health care setting to include up to two years of practitioner enrollment, credentialing or network services experience
* Demonstrated ability to work independently
* Ability to manage multiple projects efficiently and accurately
* Strong analytical skills needed to assess compliance, record, analyze and interpret data into meaningful formats
* Strong written and verbal communication skills
* Demonstrated ability and commitment to excellent customer service to maintain and ensure effective working relationships with internal and external clients
* Ability to adapt to change and meet deadlines
* Excellent attention to detail and high degree of accuracy
* Requires exceptional critical thinking skills, sounds judgment and the ability to communicate in an articulate and sensitive manner with practitioners, administrators, legal counsel and client credentialing personnel
* Certified Practitioner Credentialing Specialist (CPCS) Experience with MD-Staff or similar practitioner credentialing, data collection and record management system preferred
* Experience with NCQA, URAC and/or The Joint Commission guidelines and standards related to credentialing preferred
* Experience with MS Office preferred Our Culture: * We have a clear vision of where we are going, and we are guided by core values that embody our organization and our culture.
* We emphasizes innovation and growth, and you will be given the opportunities and tools to develop personally and professionally.
* We encourage and celebrate collaboration.
* We have a deep commitment to positively impact the communities in which we work and to make a difference in the lives of who we serve.
* As a clinical organization, we support vaccinations because we care about the health and safety of our colleagues and those we serve. Moreover, our clients are increasingly expecting us to be vaccinated due to the vulnerability of those we serve. As such, Matrix Medical Network requires that all team members are fully vaccinated against Influenza and COVID-19, unless they are eligible for a specific exemption. Credentialling Specialist Primary location: Remote or Scottsdale, AZ 85258. Regular Shift. Work From Home Opportunity Full-Time, Regular, Salaried Matrix Medical Network is an Equal Employment Opportunity Employer. It is the policy of Matrix to provide equal employment opportunities without regard to race, color, religion, sex, gender identity or expression, pregnancy, age, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. It is also the policy of Matrix that qualified individuals with disabilities receive equal opportunity in regard to job application procedures, hiring, and all aspects of the employment process. Matrix is committed to the full inclusion of all qualified individuals. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of Matrix to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, pre-employment testing, to otherwise participate in the selection process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact MatrixHR@.

Keywords: Matrix Medical Network, Scottsdale , Credentialing Specialist, Other , Scottsdale, Arizona

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