Assoc Specialist, Corp Credentialing (Remote)

Lensa; Columbus (GA); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking a Corporate Credentialing Associate Specialist for a remote position. This role involves processing credentialing applications, verifying provider information, and ensuring compliance with policies. Ideal candidates will possess strong critical thinking and communication skills, with a background in healthcare or administration being beneficial. Join a dynamic team focused on minimizing liability and maximizing member safety while meeting production goals.

Qualifications

• Experience in a production or administrative role requiring self-direction.
• Proficiency with computers and internet research.

Responsibilities

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

Skills

Critical Thinking

Time Management

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 wanting 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
• Internally motivated and driven
• Healthcare or credentialing background is helpful but not required; individuals with production-based or sales experience are encouraged to apply.
• Professionalism, excellent communication skills, and self-motivation

Job Summary

Molina's Credentialing team ensures providers meet all regulatory and risk management criteria to minimize liability and maximize member safety. This role involves initial credentialing, recredentialing, and ongoing monitoring for sanctions and exclusions, adhering to Molina policies and procedures. It also involves meeting daily/weekly production goals while maintaining confidentiality of provider information.

Job Duties

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

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 computers, internet research, Microsoft Outlook, Word, and other software.
• Strong professional written and verbal communication skills.

Preferred Experience: Healthcare industry experience.

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

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

Pay Range: $14.90 - $29.06/hour. 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 IT Consulting

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