Assoc Specialist, Corp Credentialing - Remote

Lensa; Milwaukee (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company in the healthcare sector is looking for an Associate Specialist in Corporate Credentialing. This remote role involves evaluating credentialing applications, ensuring compliance with regulations, and maintaining confidentiality. Ideal candidates will have a high school diploma and experience in administrative roles, with strong communication and critical thinking skills. Join a team dedicated to ensuring provider network integrity and enhancing member safety.

Qualifications

• Experience in a production or administrative role requiring self-direction.
• Extensive experience using a computer for internet research.

Responsibilities

• Evaluates credentialing applications for accuracy and completeness.
• Communicates with health care providers to clarify questions.
• Reviews and processes daily alerts for sanctions and exclusions.

Skills

Critical Thinking

Communication

Education

High School Diploma or GED

Tools

Microsoft Outlook

Microsoft Word

Job description

Assoc Specialist, Corp Credentialing - Remote

Assoc Specialist, Corp Credentialing - Remote

21 hours ago 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 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. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.

Job Duties

• Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals.
• Communicates with health care providers to clarify questions and request any missing information.
• Updates credentialing software systems with required information.
• Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals.
• Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants.
• Completes data corrections in the credentialing database necessary for processing of recredentialing applications.
• Reviews claims payment systems to determine provider status, as necessary.
• Completes follow-up for provider files on ‘watch’ status, as necessary, following department guidelines and production goals.
• Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.
• Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.
• Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.
  
  

Job Qualifications

Required Education:

High School Diploma or GED.

Required Experience/Knowledge Skills & Abilities

• Experience in a production or administrative role requiring self-direction and critical thinking.
• Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.
• Experience with professional written and verbal communication.
  
  

Preferred Experience

Experience in the health care industry

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $21.16 - $34.88 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  IT Services and IT Consulting

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