G-TECH Jobs

Engagement Description – Complete credentialing and recredentialing of practitioners and organizational providers based on State and Federal regulations, accreditation standards and business requirements. Provide analytical support, problem identification and facilitate resolutions to complete credentialing processes utilizing electronic Credentialing system.

Top 3 Required Skills/Experience –

• Analyze and compare credentialing data between the Council for Affordable Quality Healthcare (CAQH) database and credentialing system, Portico.

• Evaluate and investigate practitioner state licenses for actions, sanctions and/or malpractice claims history to process accordingly with summaries created in electronic file for presentation to Enterprise Credentialing Committee.

• Perform board certification and eligibility analysis for Initial Credentialing of New Graduates.

Required Skills/Experience – The rest of the required skills/experience. Include:

• Must have technical ability to self-monitor individual workload assigned in credentialing system and log issues for Supervisor review.

• Knowledge of related state/federal regulations, NCQA, DIFS, MDHHS and CMS standards for credentialing required.

• Excellent organizational skills and ability to prioritize multiple case files to meet required timelines.

• Intermediate knowledge of Microsoft Word and Excel required.

• Ability to work independently and/or in a team environment.

Preferred Skills/Experience – Optional but preferred skills/experience. Include:

• Two to Five years’ work experience in provider enrollment, credentialing and/or contracting related field preferred.

Education/Certifications – Include:

• Associates degree required

• Certified Provider Credentialing Specialist (CPCS) - preferred

• Registered Health Information Technician (RHIT) - preferred

Category Administrative

Function Clerical / Administrative

Req ID JN -032023-119842