Managed Care Credentialing Specialist
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Job Description
Managed care credentialing specialist supporting Pennant’s home health, hospice, personal care, and senior living businesses. Managing applications, re-credentialing, compliance, and payer relationships.
Responsibilities:
- Act as liaison between agencies/facilities and managed care plan partners
- Participate in strategic decisions and efforts related to new contracting opportunities
- Maintain tools and processes supporting timely, compliant, and accurate managed care credentialing applications
- Manage credentialing and re-credentialing for assigned geographic regions across the organization
- Ensure compliance with applicable policies, procedures, bylaws, rules, regulations, and accreditation standards
- Communicate with managed care organizations to obtain and verify credentialing requirements, submission guidelines, and status updates
- Complete and submit credentialing applications accurately and on time
- Coordinate with Legal, Licensing, Accounts Receivable, and Payor Admin to verify and obtain pertinent information
- Maintain a comprehensive database of agency/community credentialing documents
- Represent agencies/communities and the company professionally to managed care plans and external partners
- Assist Managed Care Resources and the team with special contracting projects
- Manage the assigned credentialing email inbox
- Respond to credentialing inquiries and provide necessary information to agencies/communities and managed care organizations
Requirements:
- Minimum of 3 years of credentialing experience or healthcare administrative experience
- Strong organizational skills and attention to detail
- Demonstrated professionalism and exceptional interpersonal skills
- Ability to adhere to strict confidentiality guidelines and operate with integrity, discretion, and strong ethics
- Strong written and verbal communication skills
- Teamwork-oriented, self-motivated, and willing to learn and adopt new strategies
- Ability to follow through with delegated tasks, assume accountability, and take initiative
- Resourcefulness in problem-solving
- Intermediate to advanced computer skills
- Proficiency in MS Office applications, including Excel, Word, Outlook, PowerPoint, SharePoint, and Smartsheet
- Proficiency with Adobe PDF
- Accuracy and results orientation
- Knowledge of commonly used credentialing concepts, practices, and procedures
- Excellent time management and multitasking abilities
- Ability to function independently with minimal direct supervision
- Ability to embrace Pennant’s core values and culture
- Home Health, Hospice, Personal Care, and Senior Living Community credentialing experience desired
- Knowledge of Managed Care Health Plans in Tennessee, Georgia, and Alabama desired
Benefits:
- Choice of medical, dental, and vision plans
- 401(k) plan with company match
- Recognition through the Moments of Truth Program
- Free e-courses through the Learning Management System
- Training sessions and seminars
- Work-life balance supporting personal well-being
- Generous PTO and holidays
- Professional development
- Empowered, flat leadership model supported by centralized resources
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