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Credentialing Specialist III

Company: Johns Hopkins Health Care
Location: Hanover
Posted on: October 13, 2019

Job Description:

Credentialing Specialist III Requisition #: 190203
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Clerical and Administrative Support
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Sept. 6, 2019

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.
This highly visibility position reports to the Credentialing Supervisor and is accountable for processing high risk credentialing files. Coordinate meetings with Chairman of the Special Credentials Review Committee (SCRC) Board, legal counsel and board members. Create, prepare and present reports to the SCRC. Create, scan and print risk assessments packets for SCRC. Create and prepare additional reports as necessary. Schedule and attend legal meetings and appeal hearings. Create meeting agenda and minutes. Ability to manage a very demanding workload with strict deadlines. Must have outstanding written, oral and interpersonal skills. Ability to effectively communicate with internal and external sources such as attorneys, medical directors and providers. Requires analytical ability to coordinator information from a variety of sources, detect errors and subtle inconsistencies in documentation. This position is highly visible throughout the entire Health System.
Requirements :

  • Education: Requires a professional level of business administration and/or management generally obtained in the first two years of college or equivalent work-related experience. Bachelor's degree preferred.
    B. Knowledge:
    Requires comprehensive understanding of credentialing policies and procedures as well as accreditation and regulatory requirements relating to managed care.
    C. Skills:
    Must be able to communicate effectively, both orally and in writing with diverse groups of people within the Health System. Must have intermediate PC skills to include MicroSoft Office, Word, Excel, including PC keyboard skills with exceptional accuracy and efficiency. Knowledge of scanning equipment is preferred. Ability to manage demanding workload; be self-motivated; be able to carry out responsibilities with minimum supervision. Requires organizational skills to prioritize tasks in order to meet deadlines.
    Adheres to professional confidentiality standards in accordance with legal, ethical, and departmental policies. Demonstrated ability to manage and resolve difficult situations.
    D. Required Licensure, Certification, Etc.:
    CPMSM or CPCS preferred but not required
    E. Work Experience:
    Requires thorough knowledge of provider credentialing, principles, methods and procedures normally acquired through a minimum of 3 years of credentialing experience. Demonstrated experience in the managed care credentialing environment such as a CVO, MCO, HMO or Hospital Based Credentialing (MSO).
    F. Machines, Tools, Equipment:
    PC, PC software applications, scanning equipment, and general office equipment. Familiarity with Vistar, Mc400, IDX and DHMH or similar systems is preferred.

    Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.

    Company Description:

    Established in 1995, Johns Hopkins HealthCare (JHHC) is the health insurance division of Johns Hopkins Medicine, and a critical partner in the Hopkins--- tripartite mission of patient care, education and research. JHHC is driven by a member-centered strategy to provide excellent service, improve health and reduce costs.-- And through data-driven analytics and innovative approaches, JHHC assures that all 400,000 plan members receive efficient and effective coordinated care.

Keywords: Johns Hopkins Health Care, Baltimore , Credentialing Specialist III, Other , Hanover, Maryland

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