Credentialing Support Specialist | PAM Health Corporate
Job Description
Company: PAM Health, LLC
Location: Boyertown, US
Overview The role of the Credentialing Support Specialist is to support the completion of Credentialing and Re-credentialing material submitted to Managed Care Organizations and provide them evidence of fully qualified facilities in PAM Health’s Rehabilitation Hospitals, Long Term Acute Hospitals and Psychiatric Hospitals. Gathers and communicates data progress regularly, to ensure operational readiness and network participation for PAM Health facilities. Provides administrative support and project work to the Managed Care Department as needed.
This position supports approximately 72 Post Acute centers in 18 states and reports to the Administrator Managed Care Credentialing. Responsibilities
I.
Position Responsibilities
Complete credentialing and re-credentialing applications (specifically tracking and initiating renewals at least 60 days prior to expiration). Maintain robust records of credentialing communications, submissions and approvals. Proactively communicate with payors to ensure end-to-end credentialing cycles.
Verify/Audit provider directory information within payor data bases. Audit internal credentialing data bases. Coordinate urgently when facilities present over due credentialing in completing re credentialing requirements given that failure to recredential can be grounds for health plan contract termination.
Support external and internal communications efforts that help accelerate the credentialing process. Prepare rosters for submission to payors. Coordinate with Administrator Managed Care Credentialing to collect, verify, and organize necessary documentation for applications.
Troubleshoot and resolve issues that may hinder timely participation with plans. Support efforts to understand recredentialing 3 year time frames and anticipate the need for timely recredentialing before Health Plan initiate it. Other duties that support the Managed Care Department as assigned.
II.
Customer Service
Maintains the highest level of customer servi
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