Assoc Specialist, Corp Credentialing (Remote)

Lensa; Sterling Heights (MI); Remote; Full time

Job summary

A leading healthcare company is seeking a Corporate Credentialing Associate Specialist to process credentialing applications. This remote role involves verifying practitioner credentials and ensuring compliance with regulatory standards while meeting production goals.

Qualifications

• Experience in a production or administrative role requiring self-direction.
• Proficiency with computers and 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

Self-Motivation

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!

Molina Healthcare is hiring for a Corporate Credentialing Associate Specialist. This role is remote and can be worked from various locations within the US.

This position processes credentialing and recredentialing applications for practitioners and facilities wishing to join the Molina Healthcare network. Responsibilities include verifying licensure, DEA, work history, professional liability insurance, training, and board certification. We support all lines of business (LOBs).

Highly Qualified Candidates Will Have the Following Experience

• Excellent critical thinking skills
• Ability to work independently with good time management
• Self-motivated and driven
• Healthcare or credentialing background is helpful but not required; candidates with experience in production-based or sales roles are encouraged to apply.
• Professional communication skills and self-motivation

Job Summary

Molina's Credentialing team ensures that providers meet all regulatory and risk management standards to minimize liability and maximize safety. The role involves initial credentialing, recredentialing, and ongoing monitoring of sanctions/exclusions, adhering to company policies and procedures. It also requires meeting daily/weekly production goals while maintaining confidentiality.

Job Duties

• Evaluate credentialing applications for accuracy and completeness, obtaining necessary verifications per policies and regulations, while meeting production targets.
• Communicate with healthcare providers to clarify questions and request missing information.
• Update credentialing software systems with required information.
• Request and follow up on recredentialing applications, collaborating with internal and external contacts to ensure timely processing.
• Perform data corrections in the credentialing database as needed.
• Review claims payment systems to verify provider status.
• Follow up on ‘watch’ status provider files per guidelines and goals.
• 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 with computers, internet research, Microsoft Outlook, Word, and other software.
• Strong 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.

Additional Details

• Pay Range: $14.90 - $29.06/hour (actual pay may vary based on location, experience, education, and skills)

Job Details

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

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