Assoc Specialist, Corp Credentialing - Remote

Lensa; Green Bay (WI); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading career site is seeking an Assoc Specialist for Corp Credentialing at Molina Healthcare. This entry-level role involves handling credentialing processes, ensuring compliance with regulations, and maintaining provider confidentiality. Ideal candidates will have a high school diploma and experience in administrative roles, with strong communication skills and proficiency in computer use.

Benefits

Competitive benefits and compensation

Qualifications

• Experience in a production or administrative role.
• Strong communication skills required.
• Healthcare industry experience preferred.

Responsibilities

• Evaluate credentialing applications for accuracy and completeness.
• Communicate with healthcare providers to clarify questions.
• Update credentialing software with required data.

Skills

Communication

Internet Research

Proficiency with Computers

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!

Job Description

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 monitoring sanctions and exclusions for practitioners and organizations, following Molina policies and procedures. The role requires meeting daily/weekly production goals and maintaining confidentiality of provider information.

Job Duties

• Evaluates credentialing applications for accuracy and completeness, obtaining required verifications per policies and regulations while meeting production targets.
• Communicates with healthcare providers to clarify questions and request missing information.
• Updates credentialing software with required data.
• Requests and follows up on recredentialing applications, ensuring timely processing.
• Collaborates internally and externally to process or terminate recredentialing applications efficiently.
• Corrects data in the credentialing database as needed for recredentialing.
• Reviews claims payment systems to verify provider status when necessary.
• Follows up on ‘watch’ status provider files per guidelines and goals.
• Processes alerts related to 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, proficiency with computers, internet research, Microsoft Outlook and Word, and strong communication skills.

Preferred Experience: Healthcare industry experience.

Current Molina employees interested in applying should do so through the intranet.

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

Pay Range: $21.16 - $34.88/hour. Compensation varies 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