Assoc Specialist, Corp Credentialing - Remote

Lensa; Rio Rancho (NM); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking an Associate Specialist for Corporate Credentialing. This remote position involves credentialing, recredentialing, and monitoring provider information to ensure compliance with regulations. Ideal candidates will possess strong communication skills and proficiency in computer systems.

Qualifications

• Experience in a production or administrative role.
• Proficiency in computer use, 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

Self-Direction

Critical Thinking

Professional Communication

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 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 requires 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 from providers and follow up as per department guidelines and production targets.
• Collaborate with internal and external contacts to ensure timely processing of recredentialing applications.
• Make data corrections in the credentialing database necessary for processing applications.
• Review claims payment systems to determine provider status as needed.
• Follow up on provider files on ‘watch’ status as necessary.
• Review and process 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 in computer use, including internet research, Microsoft Outlook, Word, and other software systems.
• Professional written and verbal communication skills.

Preferred Experience: Experience in the healthcare industry.

To current Molina employees: Please apply through the intranet job listing if interested.

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 Information

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Other
• Industries: IT Services and IT Consulting