Assoc Specialist, Corp Credentialing - Remote

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

Job summary

A leading career site seeks an Associate Specialist for Molina Healthcare's Credentialing function. This entry-level role involves credentialing, recredentialing, and monitoring healthcare providers to ensure compliance with regulations. Ideal candidates will be self-directed with strong communication skills and experience in administrative roles. Join a dynamic team and contribute to the safety and efficiency of healthcare services.

Qualifications

• Experience in a production or administrative role requiring self-direction.
• Extensive experience with computer systems including internet research.

Responsibilities

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

Skills

Critical Thinking

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!

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 ongoing monitoring of sanctions and exclusions for practitioners and health delivery organizations according to Molina policies and procedures. It 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 information.
• Request recredentialing applications and follow up as per department guidelines and production goals.
• Collaborate with internal and external contacts to ensure timely processing or termination of recredentialing applications.
• Make data corrections in the credentialing database necessary for processing recredentialing applications.
• Review claims payment systems to determine provider status as needed.
• Follow up on provider files with ‘watch’ status as necessary.
• Review and process 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; extensive experience with computer systems including internet research, Microsoft Outlook, Word, and other software; professional written and verbal communication skills.

Preferred Experience: Experience in the healthcare industry.

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.

Pay Range: $21.16 - $34.88/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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