[Remote] Operations Coordinator

Note: The job is a remote job and is open to candidates in USA. LanceSoft, Inc. is a company focused on providing quality and compliance support for a clinical Telehealth practice. The Operations Specialist role involves supporting credentialing, privileging, and payer enrollment activities for clinical providers, as well as ensuring compliance with regulatory standards.

Responsibilities

• Delivery of credentialing, privileging, and payer enrollment activities for clinical providers
• Administrative support of licensing and CME activities for providers
• Quality program support related to clinical audits, compliance and quality outcomes
• Organize, facilitate and document clinical reporting and documentation review meetings between provider staff and quality resource team
• Timely processing of initial credentialing and re-credentialing applications in accordance with regulatory requirements (NCQA, URAC, Client, or other regulatory standards)
• Validating and verifying provider credentials (licensure, DEA, specialty board, certificates, professional liability, and other required documents) through the appropriate verification sources
• Completing payer provider enrollment process, performing revalidations, maintaining CAQH profiles, NPPES registrations, provider data with payers and managing plan enrollment status in credentialing system
• Maintenance of credentialing cycles, expiration of licenses, and sanctions monitoring
• Provide and maintain a current working knowledge of credentialing standards and regulations to ensure compliance at a national level
• Review quality program requirements related to audits and ensure compliance with policies and procedures related to audit structures
• Collaborate with clinical staff to facilitate provider file reviews and clinical encounter audits, including meetings with third party reviewers
• Deliver monthly and quarterly quality and compliance reports

Skills

• Five (5) years of progressive experience in credentialing and provider enrollment
• Knowledge of credentialing, privileging, and provider enrollment regulatory standards
• Strong understanding of credentialing databases and reporting tools and/or the ability to quickly learn them
• Strong sense of ethics and demonstrated integrity in handling confidential information
• Detail-oriented, Excellent written, verbal, and interpersonal communication skills
• Analytical, problem solving, decision-making and organizational skills
• Ability to work independently to accomplish objectives accurately and expeditiously
• Bachelor's degree preferred
• Certified Provider Credentialing Specialist (CPCS) preferred
• Certification in provider credentialing from either AAPC or NAMSS is highly desirable

Company Overview

Company H1B Sponsorship