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Credentialing Specialist I
Ref No.: 18-29677
Location: Columbia, Maryland

· Responsible for performing basic Professional Provider verification following Magellan's Credentialing Policy and Procedures to ensure accurate and timely completion of the provider credentialing process. Must perform accurate and complete data entry of all provider credentialing information in provider database system. Excellent provider and internal customer service skills are essential to the successful performance of this role.

Essential Functions:

Credentialing Activities:
- Primary source verifications based on the requirements of each provider professional level. Verifications include: license; licensing board, Federal, State and Professional sanctions, general risk/liability assessment, malpractice coverage, malpractice history, education and experience, professional and board certifications. Adheres to Magellan, client, accrediting and regulatory credentialing timelines and standards.
- Assessment and referral of all credentialing materials, as necessary, to quality and/or legal review; includes tracking of this process.
- Completion and review of all provider credentialing materials in preparation for PPRC review. Communication and coordination with the PPRC review process.

Contracting Activities:
- Communication via telephone, e-mail, and US mail with Field Network staff and Provider community regarding contract documentation questions, issues, and or concerns.
- Review of contractual documents for completeness.
- Determination of appropriate network participation status.
- Review of PPRC decisions and appropriate data entry to record those decisions in the provider database.
- Execution of appropriate contractual document; update affiliations in the provider database to reflect participation status, request correspondence to providers to communicate contract status and effective dates; create website logins for providers.

- Timely, accurate data entry of all provider demographic information including tracking of applications and contracts in DocTracker.

- Perform review and analysis of incoming documents to determine completeness of applications and contractual documents. Contact providers telephonically and/or via correspondence to inform providers of missing documents/elements. Obtain missing documents and forward complete applications and contractual documents to processing units.

- Manage and track incoming faxes and documents via postal service. Record receipt in IPD and DocTracker.

· Requirements/Certifications:
A candidate who has 2-3 years' experience in the world of medical professional credentialing & contracting IS A MUST. We will have to teach systems, but this person would need to have some experience.
Computer literacy is an absolute must. Please ensure testing can be done to confirm comfort with the internet and windows-based applications, that would be great. A good candidate will be comfortable navigating screens, uploading, saving, copying and pasting, etc. Also a working knowledge of excel is helpful – just sorting and filtering – nothing too complicated.