The Maxis Group Hiring for Remote Credentialing Specialist III – Managed Care Experience Required Job at Remote Full Time

Large Managed Care Company seeking 5 Provider Credentialing Specialists.

• 100% remote
• Desired Start Date: 10/10/2022

• Initial 12-week contract with strong possibility of contract extension and/or conversion to permanent hire.
• Schedule: Monday through Friday 8AM-5PM. There may be a business need for overtime of up to 6 hours per week.

Required:

• 5 years of Managed Care Credentialing experience
• CPCS current or former certification
• Knowledge of NCQA and CMS credentialing standards
• Cactus credentialing software experience preferred.

Essential Functions:

Processing Specialist

• Process initial and recredentialing applications from providers, meeting departmental requirements.
• Complete data entry of applications, reviewing them for errors prior to turning in the provider files for quality review, meeting departmental requirements.
• Process the minimum number of provider applications each month, meeting departmental requirements.

Recredentialing/Termination Specialist

• Prepare and send out recredentialing groups, meeting departmental requirements.
• Complete 1st, 2nd and 3rd requests for recredentialing packets, meeting departmental requirements.
• Send report to various state plans/departments to identify any providers who haven’t returned their recredentialing applications or who are past-due for credentialing, meeting departmental requirements.

Ongoing Monitoring/Watch Follow-up Specialist

• Complete follow-up for provider files on “watch” status, meeting departmental requirements.
• Ensure that follow-up occurs for the ongoing state license action monitoring reports, meeting departmental requirements.
• Ensure that follow-up occurs for the ongoing Medicare/Medicaid sanctions monitoring reports, meeting departmental requirements.

Delegation Specialist

• Maintain the minimum volume of delegated provider entered into CACTUS to ensure expected levels of productivity, meeting departmental requirements.
• Enter data into CACTUS of delegate information should be done within required timeframes, meeting departmental requirements.
• Update delegate information received from delegate groups should be completed within required timeframes, meeting departmental requirements.

Job Type: Full-time

Pay: Up to $30.00 per hour

Benefits:

• Flexible schedule

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Managed Care Credentialing: 5 years (Preferred)
• Cactus: 1 year (Preferred)

License/Certification:

• Certified Provider Credentialing Specialist Certification (Preferred)

Work Location: Remote