Assoc Specialist, Corp Credentialing - Remote

Lensa; Lincoln (NE); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking an Associate Specialist for Corp Credentialing. This remote position involves ensuring compliance with credentialing processes, maintaining provider information confidentiality, and achieving production goals. Ideal candidates will possess strong communication skills and a high school diploma. Join a team dedicated to maximizing safety for members while enjoying a competitive benefits package.

Qualifications

• Experience in a production or administrative role.
• Proficiency with computer systems and internet research.

Responsibilities

• Evaluates credentialing applications for accuracy and completeness.
• Communicates with healthcare providers to clarify questions.
• Processes daily alerts for sanctions and exclusions.

Skills

Self-direction

Critical thinking

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 Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing, and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. The role also involves meeting daily/weekly production goals and maintaining confidentiality of provider information.

Job Duties

• Evaluates credentialing applications for accuracy and completeness, obtains required verifications, and ensures compliance with policies and regulations.
• Communicates with healthcare providers to clarify questions and request missing information.
• Updates credentialing software systems with required information.
• Requests recredentialing applications from providers and conducts follow-up to ensure timely processing.
• Collaborates with internal and external contacts to process or terminate recredentialing applications.
• Performs data corrections in the credentialing database as necessary.
• Reviews claims payment systems to verify provider status.
• Follows up on provider files with ‘watch’ status, ensuring compliance with department guidelines.
• Processes 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 computer systems, internet research, Microsoft Outlook, Word, and other software.
• Excellent professional written and verbal communication skills.

Preferred Experience:

Experience in the healthcare industry.

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

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

Pay Range: $21.16 - $34.88 / 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