Humera - Administrative and Professional Staffing

Provider Demographics Specialist

Minneapolis, MN, United States
Contact For Rate
Feb 21, 2018
Feb 27, 2018
Job Type
Employment Status
Full Time
Humera is seeking a Provider Demographics Specialist for our client in Minneapolis, MN. This individual will be responsible for ensuring the integrity of delegate data in the credentialing database by following NCQA, CMS and MDH standards and updating the credentialing database using the data submitted by providers to ensure the accuracy of provider directories and Find A Doc. This is a long term, contract opportunity!

  • Maintain NCQA Standards as well as state and federal requirements for provider data in the credentialing database as well as other appropriate databases as necessary to ensure accurate data for provider directories and Find A Doc
  • Assist in development and implementation of data entry policies and procedures
  • Research, analyze and process ATC forms and Service Forms
  • Ensure the integrity of all delegated profiles in which they meet the NCQA, CR, Standards as well as state and federal requirements
  • Assist with maintaining the Delegated Overdue Reports on a monthly basis
  • Assist with bi-annual meetings with all delegates to discuss any issues, new processes or standards
  • Remain current with credentialing requirements of regulatory agencies including NCQA, CMS and MDH
  • Identify any delegated practitioners that do meet UCare's criteria and present findings to the supervisor
  • Maintain timely communication with external providers regarding the eligibility and credentialing decisions and/or related provider issues
  • Other projects and duties as assigned

  • High school graduate or equivalent required
  • Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator Certification preferred
Required Experience
  • Two years of relevant experience in health care related environment, preferably in an insurance or HMO environment with exposure and familiarity with the credentialing process for providers
  • PC experience including spreadsheet, and word processing, preferably Microsoft Access, Excel and Word
Preferred Experience
  • Experience in a clinic business office, insurance or HMO environment. Delegation of credentialing/recredentialing and/or credentialing/recredentialing experience

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