Credentialing Specialist I

Overview

To gather and validate healthcare practitioner credentialing information in accordance with regulatory and accreditation standards. Interacts with practitioners by phone to ensure timely receipt of information. Responds to inquiries via telephone and email.

Responsibilities

• Performs credentialing and re-credentialing activities according to policies and procedures.
• Sends forms and related documentation and tracks and follows-up to ensure timely return of information.
• Gathers information and researches discrepancies. Scrutinizes documents for consistency and accuracy.
• Monitors healthcare practitioners licensing boards and federal and state reporting sites.
• Reviews comprehensive written documents and writes concise, accurate summaries.
• Prepares and maintains files ensuring all documentation meets standards to demonstrate policies and procedures are followed and decisions are documented.
• Educates providers on the completion of forms and required submissions.
• Prepares a variety of reports and templates using Word and Excel.
• Enters data into several databases.
• Responds to telephone inquiries.
• Other duties as assigned.

Qualifications

Education and Experience

High school diploma or equivalent; one (1) year credentialing or healthcare experience preferred.

Special Skills, Licenses and Certifications

Strong written and oral communication skills. Advanced computer skills, including proficiency in multiple software applications including Microsoft Office. Strong organizational and multi-tasking skills. Excellent interpersonal and customer service skills. Detail oriented with ability to recognize vital information. Ability to consistently maintain quality and production standards. Ability to use good judgement in making decisions and handle sensitive issues with diplomacy and tact.

Performance Based Competencies

Ability to work in a fast paced environment with multiple competing deadlines. Ability to function effectively with frequent interruptions.

Work Environment And Physical Demands

More than 70% of work time is spent using a computer. Ability to lift, carry, or move objects of varying size, weighing up to 25 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$33.65 - $40.38

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.