Assoc Specialist, Corp Credentialing

Molina Healthcare; City of Albany (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

Molina Healthcare is seeking an Assoc Specialist for Corp Credentialing, a remote position focused on ensuring provider network compliance with regulations. The role involves credentialing, monitoring, and collaboration with healthcare providers to maintain accurate records and meet production goals. Ideal candidates will have strong communication skills and experience in administrative roles, with a preference for those with healthcare industry experience.

Benefits

Competitive benefits and compensation

Qualifications

• Experience in a production or administrative role.
• Proficiency with computer systems and internet research.

Responsibilities

• Evaluate credentialing applications for accuracy.
• Communicate with healthcare providers for information.
• Process daily alerts for sanctions and exclusions.

Skills

Critical Thinking

Professional Communication

Self-Direction

Education

High School Diploma or GED

Tools

Microsoft Outlook

Microsoft Word

Job description

Assoc Specialist, Corp Credentialing - Remote

Join to apply for the Assoc Specialist, Corp Credentialing - Remote role at Molina Healthcare

Job Summary

Molina's Credentialing function ensures that the provider network meets all regulatory and risk management criteria to minimize liability and maximize safety for members. This position handles initial credentialing, recredentialing, and ongoing monitoring of sanctions and exclusions for practitioners and health delivery organizations, following Molina policies and procedures. Responsibilities also include meeting production goals and maintaining confidentiality of provider information.

Job Duties

1. Evaluate credentialing applications for accuracy and completeness, obtain required verifications, and meet production goals.
2. Communicate with healthcare providers to clarify questions and request missing information.
3. Update credentialing software systems with required information.
4. Request and follow-up on recredentialing applications, ensuring timely processing.
5. Collaborate with internal and external contacts for application processing or termination.
6. Perform data corrections in the credentialing database as needed.
7. Review claims payment systems to verify provider status.
8. Follow up on provider files with ‘watch’ status, in line with department guidelines and goals.
9. Process daily alerts for sanctions, exclusions, Medicare opt-out, and NPDB reports, taking appropriate action.

Job Qualifications

Required Education: High School Diploma or GED.

Required Experience/Skills:

• Experience in a production or administrative role requiring self-direction and critical thinking.
• Proficiency with computer systems, internet research, Microsoft Outlook, Word, and other software.
• Professional written and verbal communication skills.

Preferred Experience: Healthcare industry experience.

Additional Information

Current Molina employees interested in this role should apply via the intranet. The company offers competitive benefits and compensation. Molina is an EOE M/F/D/V.

Pay Range: $21.16 - $34.88/hour (actual may vary based on location, experience, education, and skills).

Additional Details

• Seniority level: Entry level
• Employment type: Full-time
• Industry: Hospitals and Healthcare