Appeal Resolution Specialist jobs in Georgia

Cognito Systems, a Resolution Think (RT) joint venture, is seeking a skilled Credentialing Specialist. The purpose of this overall project is to provide centralized credentialing and privileging services and support to the United States Army Reserve (USAR) Command with initial entry credentialing, maintenance of credentialing and privileging, and support the Centralized Credentials Privileging Board?s review of completed credentials and privileging files.

Essential Functions and Job Responsibilities

Individuals will be responsible for managing the verification process for all healthcare professionals (physicians, dentists, nursing, allied health). This includes reviewing applications for completion, verification of state licensure, collecting information contained in the national physician data bank, collecting information from the Health Care Integrity and Protection Databank, collection of information from State Licensing activities well as their State Emergency System for Advance Registration of Volunteer Health Professionals. Job duties will specifically also include:

• Implementing USAR policies and standards to ensure that credentialing operations are complying.
• Working with applicants and USAR staff to support and enhance credentialing functions.
• Completing verifications and ensuring that the organization and staff are in accordance with USAR directives and industry trends and standard credentialing procedures.
• Compiling all documents and building credential review files for review by the Centralized Credentials Privileging Board and documenting results.
• Generating and emailing notification letters of credentialing results to applicants and/or responding to questions from applicants regarding status of credentialing.
• Data entry into CCQAS as the official system of record.
• Prepare and maintain reports of employees based on accreditation, education, facility privileges, experience, membership and licensure, ensuring all employee information meets federal, state and local guidelines.
• Maintain regular written and verbal correspondence with agencies, hospitals, malpractice carriers and medical review boards
• Candidate may manage or supervise administrative aspects of the Contractor?s operations.