Credentialing Specialist
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Job Description
Credentialing Specialist maintaining provider credentials and data for American Health Plans' Medicare Advantage I-SNPs. Supporting CVO coordination, reporting, and committee approvals.
Responsibilities:
- Maintain and load provider demographic information received via contracts, roster updates, and/or applications to the CVO
- Review data and correct detected errors
- Keep information current and remain within departmental standards
- Extract and report data for analyses
- Help maintain database integrity and quality assurance
- Contact providers to obtain missing or incorrect documentation and follow up as necessary
- Participate in calls with network services staff to troubleshoot and recommend program enhancements
- Assist with the Credentialing Committee approval and denial notification process, including welcome and denial letters
- Complete corporate assignments and other duties as assigned
- Work with multiple departments and the CVO to ensure contracted providers meet qualifications
- Support reporting functions of provider data to agencies, committees, and management
Requirements:
- High school diploma or equivalent required
- Post-secondary education preferred
- Previous experience in the healthcare field required
- Prior credentialing experience
- Prior experience with CVO platforms strongly preferred
- Prior experience in network services data management preferred
- Prior experience with Medicare Advantage plans preferred
- CMS reporting provider and data reporting experience preferred
- Fluent in all provider types, affiliations and relationships
- Proficient computer skills
- Ability to accurately enter data into information systems
- Ability to prioritize workload and adjust to a changing environment
- Effective written and spoken communication skills
- Ability to handle multiple priorities, multitask, and meet deadlines
- Ability to work independently and accept instructions
- Travel may be required to come into the corporate office if located within 40 miles
Benefits:
- Affordable Medical/Dental/Vision insurance options
- Generous paid time-off program and paid holidays for full time staff
- TeleDoc 24/7/365 access to doctors
- Optional short- and long-term disability plans
- Employee Assistance Plan (EAP)
- 401K retirement accounts with company match
- Employee Referral Bonus Program
- Remote work from home in a dedicated office space
- Flexible hours may be available
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