Essential Functions:

* Provider Number & Payor Enrollment Management:
* Acquires provider numbers from major carriers for medical staff in large clinic system by application process (paper and online) for new hires.
* Acquires numbers to link existing providers to additional locations of practice within clinic system.
* Terminates provider numbers due to termination of employment with the clinic system.
* Maintain an extensive tracking system for pending provider numbers for a large physician data base.
* Completes applications for major carriers for all new medical providers and resolves issues or documentation requirements relating to network in-process enrollment by personal response.
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Credentialing/Re-credentialing:
* Completes re-credentialing applications for existing providers for all insurance carriers on a pre-determined time schedule and subsequent follow up to ensure continuity of approval by Credentialing Committee.
* Implements the Health Link credentialing/re-credentialing policies and procedures which comply with the NCQA guidelines for all Health Link provider applicants
* Monitors provider credentialing resource, identifies potential problems and brings them to the attention of the Health Link Manager and Health Link Credentials Chairman.
* Remains current in all aspects of the NCQA credentialing policies and procedures.
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Audits:
* Conducts bi-annual audits of the credentialing files and policies and procedures of those managed care organizations to which Health Link delegates credentialing responsibility.
* Coordinate annual audit requests in regard to delegated credentialing agreements.
* Maintains Provider Application status spreadsheet for accountability and tracking accessed by other credentialing department staff and Manager
* Maintains the provider credentialing database
* Conducts queries while providing routine monthly, quarterly and annual reports and special reports as requested.
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Filing System:
* Maintain extensive provider files for ready reference to medical credentials, application copies, and miscellaneous correspondence.
* Verify all provider application information through NCQA approved sources within NCQA specified timeframes.
* Provide accurate information to the Health Link Manager and Credentials Committee within NCQA required timeframes

Job Requirements:

* High school diploma required
* Previous credentialing experience preferred.
* Previous managed care experience preferred.
* Exceptional grammar usage and a basic knowledge of legal terms preferred.
* Competency in data base management skills, use of spreadsheet software and credentialing software preferred
* Advanced competency in verbal communication skill required.
* Exceptional organization skills and attention to detail.

At North Mississippi Health Services, our mission is to "continuously improve the health of the people of our region." Our vision is to "provide the best patient and family-centered care and health services in America." We believe that fulfilling our mission and vision calls us to embrace the best people that form incredible connections to our patients and families.

We take pride in celebrating everything that makes you uniquely you - your talents, your perspectives, and your passions. At North Mississippi Health Services, we believe in connecting your passion with a purpose. When you are part of our team, you know what connected feels like.

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