Clinical Appeals Coordinator (Remote in Philadelphia, PA) #35564
Clinical Research Philadelphia, PA
Contract To Hire Dec 13, 2023
Clinical Research
Contemporary Staffing Solutions is seeking a detail-oriented and organized Clinical Appeals Coordinator with significant credentialing/recredentialing experience. This is a remote opportunity (must be local to Philadelphia, PA)! The successful candidate will be responsible for coordinating, conducting, and documenting pre-delegation assessments, as well as annual assessments in accordance with state, federal, and accreditation requirements. The Clinical Appeals Coordinator will play a crucial role in ensuring compliance with NCQA accreditation standards and other regulatory obligations. This position requires the ability to read and interpret regulations, meet tight deadlines, and manage multiple assignments simultaneously. This Contract opportunity offers $29.93/HR!
Responsibilities:
Responsibilities:
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Coordinate, conduct, and document required pre-delegation assessments and annual NCQA assessments to comply with state, federal, and accreditation requirements.
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Conduct necessary monitoring and auditing activities to ensure vendors' compliance with state, federal, NCQA, and other applicable requirements.
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Review reports submitted by Delegated Entities, ensuring accuracy and compliance with established standards.
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Generate reports on departmental functions, including data entry accuracy and monthly trends of audits.
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Assist with data entry as needed for various reports and documentation.
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Work collaboratively with the Delegation Manager/Director to develop, establish, and maintain departmental processes and procedures.
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Perform other duties as required to support the efficient functioning of the department.
Qualifications:
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Previous credentialing/recredentialing experience
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Detail-oriented and highly organized
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Ability to read and interpret regulations
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Capable of meeting tight deadlines and managing multiple assignments
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Demonstrated ability to work independently and collaboratively within a team
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Self-motivated and enthusiastic
Contemporary Staffing Solutions (CSS) has been a leading provider of contract, temporary, temporary-hire & direct hire solutions. We began as a staffing agency and evolved to a national provider of workforce management solutions with a niche recruitment focus in Accounting & Finance, Call Center & Office, Human Resources, Sales & Marketing, & Information Technology. To learn more about CSS, visit our website: www.ContemporaryStaffing.com.