Assoc Specialist, Corp Credentialing (Remote)

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

Job summary

A leading company in healthcare is looking for a Corporate Credentialing Associate Specialist. This remote role involves processing credentialing applications, verifying provider information, and ensuring compliance with regulations. Ideal candidates will have strong critical thinking skills and proficiency in communication. Join a dynamic team that values self-motivation and offers competitive benefits.

Qualifications

• Experience in a production or administrative role 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.
• Update credentialing software systems with required data.

Skills

Critical Thinking

Time Management

Professional Communication

Education

High School Diploma or GED

Tools

Microsoft Outlook

Microsoft Word

Job description

Assoc Specialist, Corp Credentialing (Remote)

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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 wishing to join the Molina Healthcare network. Responsibilities include verifying licensure, DEA, work history, professional liability insurance, training, and board certification. We support all lines of business.

Highly Qualified Candidates Will Have the Following Experience:

• Excellent critical thinking skills
• Ability to work independently with good time management
• Self-motivated and driven
• Healthcare or credentialing experience is helpful but not required; individuals with production-based or sales experience are encouraged to apply
• Professional communication skills and self-motivation

Job Summary

Molina's Credentialing function ensures the provider network meets regulatory and risk management criteria to minimize liability and maximize safety. This role involves initial credentialing, recredentialing, and ongoing monitoring of sanctions and exclusions, adhering to Molina policies and procedures. The role also involves meeting daily/weekly production goals and maintaining confidentiality of provider information.

Job Duties

• Evaluate credentialing applications for accuracy and completeness, obtain required verifications, and meet production goals.
• Communicate with healthcare providers to clarify questions and request missing information.
• Update credentialing software systems with required data.
• Request and follow up on recredentialing applications, collaborating with internal and external contacts.
• Perform data corrections in the credentialing database as needed.
• Review claims payment systems to determine provider status.
• Follow up on ‘watch’ status provider files as necessary.
• Process alerts for sanctions, exclusions, Medicare opt-out, and NPDB reports, taking appropriate actions.

Job Qualifications

Required Education: High School Diploma or GED.

Required Skills and Experience:

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

Preferred Experience: Healthcare industry experience.

Current Molina employees interested in this position should apply through the intranet.

Molina Healthcare offers competitive benefits and compensation. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $14.9 - $29.06 hourly. Actual compensation may vary based on location, experience, education, and skills.

Additional Details

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

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