Assoc Specialist, Corp Credentialing (Remote)

Lensa; Cincinnati (OH); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking a Corporate Credentialing Associate Specialist to process credentialing applications for healthcare providers. This remote role requires strong critical thinking and communication skills, with a focus on ensuring compliance and accuracy in credentialing processes. Ideal candidates will have experience in production or administrative roles, and proficiency with Microsoft Office tools. Join a dynamic team committed to maintaining high standards in healthcare credentialing.

Qualifications

• Experience in production or administrative roles requiring self-direction and critical thinking.
• Proficiency with computers and internet research.

Responsibilities

• Evaluate credentialing applications for accuracy and completeness.
• Communicate with healthcare providers to clarify questions.
• Process alerts for sanctions and exclusions.

Skills

Critical Thinking

Time Management

Communication

Self-Motivation

Education

High School Diploma or GED

Tools

Microsoft Outlook

Microsoft Word

Job description

Assoc Specialist, Corp Credentialing (Remote)

Be among the first 25 applicants. Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Molina Healthcare is hiring for a Corporate Credentialing Associate Specialist. This role is remote and can be worked from various locations within the US.

This position processes credentialing and recredentialing applications for practitioners and facilities wanting to join the Molina Healthcare network. Responsibilities include verifying licensure, DEA, work history, professional liability insurance, training, and board certification, supporting all lines of business.

Highly qualified candidates will have the following experience:

• Excellent critical thinking skills
• Ability to work independently with good time management
• Internally motivated and driven
• Healthcare or credentialing background is helpful but not required; candidates with experience in production or sales roles are encouraged to apply
• Professionalism, excellent communication skills, and self-motivation

Job Summary

Molina's Credentialing function ensures providers meet regulatory and risk management criteria to minimize liability and maximize safety for members. This role involves initial credentialing, recredentialing, and ongoing monitoring of sanctions/exclusions for practitioners and health delivery organizations, adhering to Molina policies and procedures. The position also requires meeting daily/weekly production goals and maintaining confidentiality of provider information.

Job Duties

• Evaluate credentialing applications for accuracy and completeness, obtaining required verifications per policies and regulations while meeting production targets
• Communicate with healthcare providers to clarify questions and request missing information
• Update credentialing software with required data
• Request recredentialing applications and follow-up accordingly
• Collaborate with internal and external contacts to ensure timely processing
• Make data corrections in the credentialing database as needed
• Review claims payment systems to verify provider status
• Follow up on ‘watch’ status provider files
• Process alerts for sanctions, exclusions, Medicare opt-outs, and NPDB reports, taking appropriate actions

Job Qualifications

Required Education: High School Diploma or GED.

Required Experience/Skills:

• Experience in production or administrative roles requiring self-direction and critical thinking
• Proficiency with computers, internet research, Microsoft Outlook, Word, and other systems
• Strong professional written and verbal communication skills

Preferred Experience: Healthcare industry experience

Current Molina employees interested in this role should apply through the intranet. Molina Healthcare offers competitive benefits and compensation. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Additional Details

Pay Range: $14.9 - $29.06/hour. Actual compensation varies based on location, experience, education, and skills.

Job Details

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Other
• Industry: IT Services and IT Consulting

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