Assoc Specialist, Corp Credentialing (Remote)

Lensa; Detroit (MI); 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 excellent critical thinking and communication skills, with a focus on accuracy and confidentiality in managing provider information.

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.
• Process alerts related to 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 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
• The ability to work independently with good time management skills
• Internally motivated/driven
• Healthcare or credentialing background is helpful but not required. Those with experience in production-based or sales roles are encouraged to apply.
• Professionalism, excellent communication skills, and self-motivation

Job Summary

Molina's Credentialing function ensures providers meet all regulatory and risk management criteria to minimize liability and maximize safety. 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 requires meeting daily/weekly production goals and maintaining confidentiality of provider information.

Job Duties

• Evaluate credentialing applications for accuracy and completeness, obtaining verifications as per policies and regulations while meeting production targets.
• Communicate with healthcare providers to clarify questions and request missing information.
• Update credentialing software with required information.
• Request recredentialing applications and follow up accordingly.
• Collaborate with internal and external contacts for timely processing.
• Make necessary data corrections in the credentialing database.
• Review claims payment systems to verify provider status as needed.
• Follow up on ‘watch’ status provider files.
• Process alerts related to 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 a production or administrative role requiring self-direction and critical thinking.
• Proficiency with computers, internet research, Microsoft Outlook, Word, and other software systems.
• Strong professional written and verbal communication skills.

Preferred Experience: Healthcare industry experience.

Current Molina employees interested in this role 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: $14.9 - $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 IT Consulting

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